Estoy nadando.

 After a cold grey day, the sudden orange glow lighting up my blinds told me that before it was too late the sinking sun had decided to bid New York a fond farewell to it's 2017 face. I braved the frigid air to stick my head out and return the farewell.

There's a concise little article floating out there entitled, "How to Swim with Sharks." I read it years ago, in medical school I believe was the first time, but paid it no mind. I just want to do my job, and will ignore the sharks, I naively thought. It was placed back in my hands just recently, drawing me out of my tendency to ignore what needs to be addressed. And reading it again this time I realized just why I chose to ignore it in the first place. Things like " Use anticipatory retaliation." and "Get out of the water if someone is bleeding." Quite honestly make me uncomfortable to read, let alone picture myself doing.

      "Actually, nobody wants to swim with sharks. It is not an acknowledged sport and it is neither enjoyable nor exhilarating."

Yet here I am 2018, swimming with sharks. ...I think I need to hang out with more fish.

I had a couple more paragraphs further illustrating shark infested waters, but it felt good enough to illustrate them for myself, and don't actually need to be shared, so I have saved them away elsewhere.

I wish all the fish, the ponies, the lambs, the elephants and all the sharks out there a Happy and Blessed New Year's.

Much Love.

Estoy empezando tradiciones.

As I left the hospital late Christmas Eve, I unknowingly brought the day along with me. I packed a bag and got in the car pointing it NorthEast towards Connecticut. I brooded as I drove, thinking over conversations and patient interactions. Slightly desensitized to the Christmas music, even turning the radio up louder was unsuccessful in distracting me.

Christmas has as many different definitions as there are people in this world. 

He had drunkenly fallen and smashed his face. A deep laceration extending beyond the hairline kept painting his stretcher blood red, with occasional spurts hitting as far as the wall beyond his stretcher. As I set to work squelching the hemorrhage, I took a scissors to his hair clearing a way around the gash. I hadn’t asked his permission exactly, rather just told him I was going to give him a haircut. Trying to make light of the fact, I commented on how he’s now going to have a great conversation starter for the holidays. To which he responded with a snort and a “yea..” that trailed off into thought. 

She had fallen three days ago, hadn’t felt quite right since. In accordance with her independent nature, she tried to tough it out on her own, thinking that “this too shall pass.” But it didn’t pass, and finally her husband got tired of her moaning and brought to her to the hospital. Her story about the fall... all a distractor and unrelated to the fact that her intestine had a nice big ulcer, perforated and making her sick. Within an hour or so she was on her way to the OR telling us all she would pray for us, and family was on their way in. I’m sure not in their original plan for the holiday festivities this year.

Their baby had been vomiting for a week. They’d tried changing formula without improvement; anything they gave the little guy came right back up. Unsure what to do next they had presented for evaluation. Turned out, he needed a surgery. Perhaps the surgery could be done immediately and if all went well they could still get home on Christmas! But, lacking empathy for the holiday, the surgeon opts to wait to do surgery until the following morning.  They hide their disappointment, thanking the surgeon for being willing to help their little boy. 

In all of the above, Christmas held a very different meaning for each person involved. 

Without the large social events of the season: church, mass, family, parties, gifts. Without the traditions. Without anything. It’s just you. And humanity. What does or doesn’t Christmas mean to you?

https://www.youtube.com/watch?v=5Vwu-t7QRaE&feature=share

Noel by Chris Tomlin
Noel, Noel
Come and see what God has done
Noel, Noel
The story of amazing love!
The light of the world, given for us
Noel

Much Love.

Estoy apurandome.

Some days are better than others. Some weeks. Some years. And then some just can’t seem to catch a break. We have one patient on our list under thoracic surgery. A smart individual would hear this patient’s story and apologize but kindly decline. Except for the fact, that thoracic surgery really was their only chance. Biopsy showed there was no option for medical management. The mass had to be removed, because with the mass the patient could not get their heart transplant. Any way you tried to look at the situation it was either take a chance with surgery or let the disease(s) follow it’s natural course. And frankly, we weren’t caught in a corner yet, no one even mentioned ‘give up.’ So we went to the OR. I had attended a conference that morning to present some research and was just leaving when my chief texted asking if I was done yet. This was followed by three lines.

Our patient is coding.

Doing compressions.

Please come to room 8.

Like I said, some just can’t seem to catch a break. Our patient was placed on pumps, tubes and lines and taken to the ICU. Case aborted. The following day the patient’s chest was opened for more tubes and lines. We took the opportunity of an open chest and tried again for the lung mass, successful removal this time. Next step, heart transplant. Well… we’ll get there eventually.  

So next time you’re having a bad day… it could be worse.

Much Love.

Estoy aprendiendo como los tiempos cambian.

There's a current popular contemporary christian song that has frequently been finding its way into my afterthoughts. One line in particular. "We all bleed the same." The artist sings advocating love one towards another. I was thinking about it as I watched my fellow travelers fill the airplane last weekend. Single file line, waiting for the aisle to clear, then continuing on towards their designated seat. I would watch their faces, and imagined a sketch book that God had taken, pencil in hand, into which He etched each eye crinkle and hair curl, and made the jaw line just so. There were no two faces the same. Each completely unique. Each completely beautiful.

We all bleed the same.

We're all beautiful. Created down to the last eyelash with the same loving hand. Each one.

I was on my way to Illinois. Got to spend about 40 hours with my nephews and celebrate Christmas with the family.

 Peter Bear

 Little Lincoln

and Miles Austin

Group effort opening Miles' Christmas gift!!

Back at work this week, doesn't even feel like I missed a beat. Not much had happened over the weekend that I hadn't already set up for before leaving on Friday. Made it easy to pick it back up again right in rhythm.  Waiting to sign out this evening I sat and listened as my chief bemoaned the fact that she's taking two weeks vacation over the holidays. How busy she is going to be seeing all of her family and all of her fiancee's family, and how tired it will make her that it won't feel like a vacation at all.  As I listened I heard the song playing through the back of my mind again. No matter how different we are; we all have been created with love. We're all beautiful. We all bleed the same.

Much Love.

Estoy preparando.

1. We went.
2. He’s okay.

And they weren’t joking! I got to do the whole case!

Estoy calculando el riesgo.

There’s some names that everyone knows. A patient that has been at the hospital months on end, just about every resident has been involved in some aspect of his or her care. Or a patient, for good or bad, who is a frequent flier on the surgical service.
This particular gentleman is the later example, a frequent flier.  Every couple of weeks he shows up as a direct admit to the floor. Sent in from clinic with abnormal lab values, or another virus. He usually walks in with his suitcase, “here to check in again!”  So, when I saw his name on the ICU census, I was very surprised. Considering how closely he is followed, anything and everything should be caught in early stage. Soon enough to stop it in its tracks.  Evenso, he’s there, critically ill, fighting for his life as he does everyday just now with higher stakes.  I was then even more surprised to hear his name mentioned by my Thoracic surgery attending. “They want a lung biopsy, so you’re going to do it Christy. No one is going to take this from you. A lot of the bad stuff is in the region of the lingua, so we’ll take a wedge of that. And this one’s yours Christy!” At least that’s what she told me. Another story when we talked with the ICU team. “Absolutely not!!!”  They seem to be under the impress he’s way too critical to survive even leaving his room let alone allowing us to position him on his side and collapse a lung to do surgery. I got consent from the surrogate just in case, we do get to go.
1) Will we get to go?
2) Will he be okay?

Estoy pensando en la navidad.

Hitting the Christmas music pretty hard this year. Wish I could carry it around with me throughout the hospital.

Change of rotations today. Always leaves the teams short staffed. We are supposed to have eight 2nd year residents in our program. We are now officially down to 5 of us. So short staffed on top of starting with a severe handicap left me as the only 2nd year resident at the hospital today. Every single chief didn’t ask, just went ahead and used me in their 2nd year position. Thoracic and consults. Trauma. Vascular. General Surgery. I guess one did ask. “Hey Christy, are you busy?” Yes, actually I’m very busy. “Oh, well, come and scrub me out of this case.” So he didn’t really ask.

At a time when one of my Thoracic patients was not doing too well up on the floor. Two vascular patients were in the ED needing admission, booking and consenting. And the pages went out for two traumas to come in. My chief texts to ask if I’m there. Says she’ll look for someone to help me. Thankfully, another one of my co-residents actually just showed up, instead of saying they’ll see if they can help. Then in the middle of the two activations one of my Attendings calls me to ask how I am. (A little background: earlier in the day I had asked this Attending for help, and he had tried to weasel out of it as quick as he could) So exasperated I was at the general show of caring with no action to back it up, that without thinking I barked into the phone that I was “FINE!” While thinking to myself, you’re off the hook sir. No worries! We got this! Thankfully I immediately caught myself and lost the bark.

Sigh, hence the Christmas music. Lots of Christmas music!

Much Love.

Estoy cansada.

I’ve learned that I am not allowed to complain. Especially in the presence of nurses. Even if you’re just trying to empathize with a group of complaining nurses, they’ll shut you down right fast. Wag a finger at you saying, “you signed up for it.”
So I’ve learned to simply listen intently and agree with whatever they need my assent on. And no matter how I’m feeling, or the day is actually going, when asked, the appropriate response is always, “Living the Dream.”

Most of the time, it’s the truth. But then sometimes, it’s about all you can do to look straight and keep calm. For me, those times come when I’m already baseline exhausted. As a surgical resident, we will acknowledge that we walk around the hospital with baseline GCS14. (Ideal is GCS15, we lack that last point due to constant state of confusion and lack of orientation to time) But when I can’t seem to clear the exhaustion fog, work gets blown out of proportion in my mind.

It happens to us all. This month, the intern and I ran ragged keeping the vascular ship afloat. My studying time has severely suffered. Next month is looking like it will be more of the same. Living the dream! Living the dream!

Much Love.

Estoy orando.

I had a patient declare my doppelgänger to be Amelia Earhart today. We had just finished our case during which I had deployed a filter within his inferior vena cava. But had only used a bunch of local to do so, therefore he supposedly was considered to be at his baseline of alert and oriented x 3. The last time someone tried to assign my doppelgänger as a Russian American actress, my family immediately veto’d that idea.

He persisted with his statement that I looked like Amelia Earhart, until I flipped him up on his side in order to move him off the OR table. Despite the usual warning, the movement startled him. To which the Anesthesiologist reassured him, “don’t worry, she’s never dropped anyone.... yet.” Either way, we were finally distracted away from any supposed look alike.

My chief told me not to come to the hospital this past Friday. I’ll be honest that it caught me off guard, and I was hesitant at first. But when I was able to collect what it ment... 48 hrs away from the hospital... I didn’t dare argue with that, opting instead to hold my breath until it became reality. After leaving the hospital Thanksgiving night I packed a bag and fled. I spent two whole days up with family and friends in CT. Much fellowship, great conversations, good food (Thanksgiving left-overs included) and some time to study! In the absence of being able to attend church, it definitely did my soul good.

Much Love.

Estoy una chica aburrida.

You know the phrase “all work and no play makes Jack a dull boy.” A proverb,  been floating around for a couple of hundred years. Who knows where it actually originated from. Maybe was even some kid trying to explain to Mom why the chores aren’t done. Doesn’t really matter.
I wonder, has anyone ever asked if maybe Jack was just a dull boy to start with?

Residency has a sort of monotony to it. My friends all periodically move, or change jobs, or have another kid. Something new, and I’m still here, just working. Makes my life dull in all appearances. But on top of that, God granted me a rather dull personality to begin with. I learned years ago that it is best to be friends with funny people. Then all I have to do is laugh and we get along great. And I love laughing, so makes it easy for everyone.

That’s not to say I never make a joke. Why just the other day I tried my hand at it. Granted the Attending took me seriously and then I had to backpedal pretty hard to reassure him that I had, in fact, only been joking. Fail #1. And then later that day when I was recounting the interaction to my team in hopes of maybe getting a secondhand laugh at least, my chief, who is the Ukrainian soldier amongst our crew, without looking at me simply responded, “Don’t joke.” Fail #2.

On the other hand...

I once had one of my medical students look at me and say, “You know... if someone called you and said “The world is ending!!! You’d calmly respond, “okay, meet me in 5 minutes, and we’ll discuss.”

There’s many different personalities in this world. And with a little bit of faith it’s easy to see just how well orquestrated it can be. We can use our different strengths to work together. I must concede, and let others make the jokes. After all, they need people to laugh at the joke, same as I need someone to make the joke. We all have our roles.

In the end, I know there’s no hope in challenging a proverb that hundreds of years old. But, what’s wrong with Jack being dull?

Much Love.

Estoy escondiendo historias.

There were random spackles of raindrops when I left my apartment this morning. But with each step there was an audible crescendo, until an all out downpour was chasing me in through the trauma bay doors. I tilted my head forward and the rain I’d caught on my way in dripped down my nose in a steady stream. Just another day.

Sometimes I have stories that I keep to myself. Stories I’ll never forget, each with their own treasure. I say that to perhaps give myself an excuse for not sharing anything the past while. The stories have been for me alone.

But in all honesty, I feel as if a cloud of gloom is currently settled over Westchester surgery residents. Can’t seem to shake it. May just be myself, and wanting a weekend, and then projecting my own gloom onto my co-workers. But even that is beyond my abilities of diagnostic psychiatry. Just going to have to start by smiling more myself.

Much Love.

Estoy operando.

By the time I got home from the hospital last night, I was so thankful at the prospect of being able to sleep in today I could have cried from happiness.
Things are really busy right now. Transitioned to the Vascular Surgery service with the change of the month. My new team unfortunately inherited a mess as the outgoing residents, nice people, but horribly unorganized. We kept our heads above water though. Always do.

Even though I end up being exhausted, chronically dehydrated, and gnawing away at a stomach ulcer.. really busy is actually really good as it means that I am operating.

This week...
I got to reconstruct a patient's abdominal wall using pig bladder.

I got to sew a graft into a patient's arm. I had worked with this particular attending once before on the same operation. Last time, as the Attending hit a nerve causing the patient's arm to jump, it spooked us both causing us to jump in reaction and she therefore then blamed me for the whole thing. This time when she hit the nerve, causing the patient's arm to jump and her to jump in reaction, my hand stayed rock steady. Couldn't blame me this time! Calm outside, victory dance inside!!

I got to take out a patient's thyroid gland, and then 4 hours later go back in to evacuate a hematoma. Lesson in sticking with my patient, being honest and doing what's right, even if not the easiest option.

I got to cut off a patient's toe.

I got to open up areas of horrible infection. You breath through the mouth and wonder at how patient's can let infections go from bad to worse to festering, foul and dead.

I got to take down a patient's colostomy and hook everything back up again.

I got to cut out part of a patient's stomach. Why anyone would electively decide this is a good decision is beyond me and can not in good conscious ever recommend it to anyone.

Just a few for example..

But today I slept until an army of lawn mowers decided to wake me up. Army, because upon peeking through the blinds at the culprit I saw not one but four riding lawn mowers zooming around and a handful of leaf blowers following behind. I decided to get up and start working on rehydration and laundry.

Much Love.

Estoy ir de compras para zapatos nuevos.

The wear and tear of life is expected. One deals by coping with whichever choice mechanism they prefer. Some may take precautionary and preventative measures, such as face creams and skin oils, padding the soles of their shoes and taking daily vitamins. Others may deal by rebellion, live to the fullest while they can, and can typically be found in a situation involving alcohol or other mind altering substance. I'm starting to detect one such pattern in my life, and am realizing I may fall into a subgroup category that copes by simply ignoring the wear and tear even exists.
Take my shoes as example. They started falling apart a long time ago, so I stitched them back together, twice. Each time the stitches rubbed through. I didn't get the message.  I just tried taping them back together instead. Nope, message still not computing. The other day the sole itself cracked in half. Okay, I think I finally get it now.

Time for new shoes.

Much Love.

Estoy practicando mis palabras.

I went to my first deposition today.

I received the deposition subpoena some time ago and quite honestly did not know what to make of it. Thankfully my lawyer met with me last week to answer any questions that I had as to my role and what to expect.

Advice that I received from various sources:
- Do not volunteer information.
- Answer yes or no.
- Always think and/or pause at least 2 seconds before answering.
- Whatever you do, don’t get angry.
- No matter how nice he is to you, the plantiff’s lawyer is NOT your friend.

I asked my lawyer if she likes depositions, as I could not imagine doing this as a job. Without directly saying yes, she instead gave examples that I could understand just how a lawyer loves the thrill of a deposition.

And I saw it first hand. Rapid fire questions requiring you to be on edge the entire time. Correctly placed “objections” to protect your client. The entire time a word game to catch a lie or incriminating words. Things can escalate quickly.

One of my attendings told me his longest deposition was eight hours. Thankfully mine did not last that long. But it gave me a new appreciation for lawyers, as in a way I could relate to the focus and mental stamina they must possess. Think of a liver transplant, one that goes well lasts roughly 5hours with the most important part 4hours into the case. Loss of focus for a second and the stitch is misplaced, the duct transected, or anastamosis under too much tension.  Likewise a lawyer’s loss of focus four hours into the deposition and they miss the question that is reworded and reasked for the 15th time and the client answers before they can object. And just like in the transplant, things can escalate quickly with perhaps poor outcome.

I am thankful for lawyers, and will gladly leave the word games to them.

Much Love.

Estoy joven.

My parents and sister visited this past weekend. I was granted the weekend off from my responsibilities at the hospital to spend the time with them. The Cloisters were recommended to me prior to my moving out East, and had remained on my list of places to see since that time. I finally was able to make a triumphant check as the four of us stopped by Saturday morning.

 View from the Terrace, GW Bridge half obscured by fog. 

 A place to sit. A story to tell.

 Fellowship Hall

 "Plants used in Medievel Medicine"

"Self Heal, All-heal"

 

Much Love.

Estoy escuchando el ritmo.

The day almost got by me without a single case. I was taking the opportunity to complete some paperwork and research. I even got to eat lunch with my team! But I did say almost, almost got by me. Flight EMS rolled through the trauma bay doors asking where to take the aneurysm. This coincided with the Vascular chief calling me to look out for the same aneurysm and see it immediately. Less than an hour later we had our hands in his belly, one goal on our mind. Control. Get control first. Aneurysm second. I don't think I've ever listened so intently to the beeping monitors at the head of the bed before. The steady beep, signifying the rhythm of life, the heart rate. I listened to that beep the whole case long, wondering just when, if when it would suddenly stop. We kept working, the beep remained steady, and eventually I started to notice the crowd of anesthesia at the head of the bed started to thin down. They started moving slower, and then they started relieving each other for breaks. The beep kept going, and so did we. By the time we finally finished and safely got our patient to the ICU, it was late.


Much Love!


Speaking of rhythms... It's been awhile since I've shared one. Here's a rhythm I've been enjoying the recent past while.

Estoy sola.

The team I have been assigned to this month has changed its political makeup since the last time I flew its colors, carried its banners, and yelled its war chant. Ha, kidding... but not really. It's almost like three individual houses banded together under a single title with one Chief. Although, in reality, the houses govern themselves, and the chief stands there and smiles. And as for my role?... The word that comes to mind is a PAWN. The least valuable player, I have no say over where I go, or what I do. And at the same time, the most valuable player. Every morning its like I'm auctioned off to whomever claims me first. Oftentimes this auctioning continues throughout the day and my assigned cases are often changed and rearranged. I'm strategically moved wherever and whenever the chiefs desire pending case loads of all teams and which residents are actually available for the day.

There's a part of me that protests at feeling used and abused, but I get over it quick enough, because at the end of the day I'm in the OR.

Much Love.

Estoy esperando.

Another month down, just 45 short months yet to go. I leave this month of pediatric surgery, and am thankful to see a few of my kids get to leave with me. I've mentioned before my strong distaste for perforated appendicitis. We had more than a few come through this past month. It's not fun watching a child suffer. Mom & Dad struggle with it even more. And it doesn't matter how many times you answer their questions, reassure them, explain the situation to them, TIME is not the treatment anyone wants to try. Usually, as the care provider, you find yourself plowing ahead with TIME, albeit with very unwilling occupants on board. Mom & Dad following along begrudgingly. The patient, sometimes dragging their feet, other times planting their feet requiring you to bring them along kicking and screaming.

One such patient came to us early morning, so sick her various organ systems had already started failing, mental status altered to the point of nonresponsiveness. It took days before I even saw her with her eyes open. After that, initially all she could muster was a whimper. But she wouldn't stop whimpering until I had left the room again. As she continued to heal, her strength came back, followed by her voice, and what was once a whimper grew to an all out protest. Of course which would end only by our exit. She didn't speak English, so I couldn't explain what was happening, couldn't tell her I loved her. All she saw was that when I came into her room, someone was going to push on her belly, or mess with her tubes, and not allow her to eat or drink. I'd hate me too! But even after belly felt better, tubes came out, and she could finally eat again; she still loudly protested our presence. So I refrained from patting her messy head of curls, approached her bedside only when necessary standing instead a foot or so back when speaking with mom & dad, and took care to always smile at her. Maybe when she's old enough to remember and understand what happened to her here, she'll finally forgive me.

Protesting is one thing when it's limited to words, but when another's protests resulted in a swing narrowly missing my nose, I called for backup. When a few moments later a med student had come to my aid, I gave him only one instruction. "Don't let her kick me!"

The human body is amazing. Especially in kids, when its still a new and healthy body that's really good at healing itself. It'll do so, despite the protests of its inhabitant, just takes TIME.

Much Love.

Estoy luchando contra el estrés.

Throughout the residency year, education follows a somewhat loose curriculum. There is a nationally produced list of core competencies that must be taught. This is for all residencies, how surgery teaches them versus pediatrics versus radiology, etc, is up to the program itself. Just as long as when the ACGME comes calling, the individual program can show proof that they are being taught. It is also required to provide support and awareness about stress and sleep. Personally, I inwardly groan when it comes time for such a lecture. 1) I won't learn anything new  + 2) there's a million other things I could be doing instead  = 3) this lecture is a waste of time.

So when I got a phone call from one of my chiefs this past week telling me to go listen to a guy talk about stress, I really wished I hadn't picked up the phone. But I also knew that at least half of the residents were going to successfully be able to come up with a good excuse on the spot and avoid going. Therefore I headed over to listen.

One of his powerpoint slides was somewhat similar to the following...
Medical students
     Depression rate - 27%  (corresponding rate in the general population 4-5%)
     Anxiety and burnout rates grater than 50%
Residents
     Burnout rates - 60-75% and higher
Practicing Physicians
     Depression and suicide (Physician is the profession with highest suicide rate in the US, has now officially surpassed Dentists)
     Burnout - 54%
     Would not recommend the field to their kids - 60-90%

Don't quote any of those... I didn't actually catch the guy's source for reporting such rates. But he was just making a point, and trying to reinforce the point by giving examples. Why do 27% of medical students report being depressed when for that same group of individuals only 4-5% (normal rate corresponding with the general population) reported struggling with depression on their medical school admission. What about medicine/medical school/healthcare causes depression rates to increase by roughly 500%?

One can't actually answer that question in a one hour lecture. That's for psychologists, anthropologists and the like with much discussion, much thought, and even more time.
He did though, quote Viktor E. Frankl.

“A man who becomes conscious of the responsibility he bears toward a human being who affectionately waits for him, or to an unfinished work, will never be able to throw away his life." 

“Those who have a 'why' to live, can bear with almost any 'how'.”

I will spare you the details of the HOW, but the WHY, is something that thankfully, I have never struggled with.  And if I took anything away from this one hour lecture about stress, was just affirmation that I am incredibly blessed. I traverse along this path with so much unknown, but before I had even taken my first step, back before I knew anything, I knew the WHY. There is still much HOW I must traverse, but my WHY is the same yesterday, today and forever. 

Much Love.

Estoy escapando a Narnia.

I was passing through the NICU the other day when one of the Nurse Practitioners stopped me.
"Has anyone asked you about Baby B?" he asked me.
"Yes," I replied, "I need to ask Dr. X if he has availability."
To which the NP responded, "Oh he was just here and said he couldn't do it."
"Alrighty, then Dr. Y is coming tomorrow at 3pm so will then be able to ask him when he would like to do the case"
"Ah yes," sighs the NP. "But, the baby really needs the surgery sooner."
Blink. Blink.
I reiterate..."Dr. X said no. Dr. Y is not coming until tomorrow afternoon, at which time Baby B's case will be presented, and surgery planned accordingly.
The NP sighs again, "ahhhhh, but he really needs surgery now."
Blink. I decided not to try again..
I think.... I think, he thought I had some sort of magical power. The ability to create an Attending out of thin air, who could then do surgery on cue and then *poof* disappear again.


Or another great memory of the week, when a couple of the general pediatric hospitalists ganged up on us about a patient. Wagging fingers and shaking heads, casting blame. "This is surgery's fault. This is YOUR fault!" It doesn't matter that I'm in that room talking with the family everyday, explaining everything. The patient has been operated on by three different surgeons, none of them our own pediatric surgeons.  There's no one around to actually claim her as their patient. No one taking ownership, and seemingly zero continuity.
 

“This is the land of Narnia,' said the Faun, 'where we are now; all that lies between the lamp-post and the great castle of Cair Paravel on the eastern sea.”

We call it Narnia. We walk by these windows on our hurried ways to and from the ORs. Somedays the desire to find the wardrobe and escape reality is rather strong. I look out the windows and want to leave. At the same time, its calming to see a kind of peace and to be reminded that our current reality is so very small and quickly passing. I look out the windows and then move on.

Afterall, “She remembered, as every sensible person does, that you should never never shut yourself up in a wardrobe.”

Much Love.

Estoy volviendo vieja.

I don’t mind all the little appy’s that come in. They’re often quite cute, each with their own uniqueness. We take out their appendices and then they go home. Easy peasy. Unfortunate it is, when that cuteness turns very. very. ugly. When the cute little appendix opens up and spills it’s undesirables all over someone’s unsuspecting and undeserving abdomen. I really don’t like perforated appendicitis. I’ll say it again. I REALLY don’t like perforated appendicitis.

The other day I went to the ED to see one of the cute appendices. He looked at me. He looked at my ID badge. Then he looked back at me and asked, “Why do people always look younger in their pictures?” Cute. Ha. Cheeky.

Much Love.

Estoy cansada.

It's been a week into the month on Pediatric Surgery, and to be totally honest, I'd have to say I'm not enjoying it as much as last time. The patients are as cute as ever, the surgeries as challenging as ever. It's not them. Rather, it's the political drama and the current tenuous state of the pediatric surgery service in general. Two of our Pediatric surgeons have moved on and away from Westchester in their careers. To keep up with the volume and demand on the service, surgeons have been rotating through, hired for a couple weeks, and then they move on. We had a new one start earlier this week. Unfortunately, he didn't arrive until late in the day, and the previous surgeon had moved on the day before. It's unfortunate and awkward as the resident on the service. I get paged, a new consult, what do I tell them... sorry but can't help? No one wants to work here, and I'm just a poor orphan resident. Don't worry, I don't tell them that. No, I just save everything, and when our new Pediatric surgeon arrives the unloading begins. Welcome to Westchester!! Let's get to work! 

Much Love.

Estoy disfrutando las mañanas.

About to head into work for the last night of the month, and then back to the light of day again! All-in-all the month went as well as any night float month one could ask for. Learned so much. Was able to scrub into a handful of cases which were left over from the day. Another handful of bedside procedures, still hungry for more though. Even have to admit I had fun on nights! It makes a huge difference who your teammates are. My senior resident was Monica this month. One of our goals in working together was efficiency, and we got pretty good at it. We'd time ourselves when a consult for appendicitis would come in. So far have it down to 17 minutes start to finish! Patient seen, admitted, consented and booked!  We'll aim to break that yet tonight! ;)

These past two weeks, we pushed each other to get some exercise as well. After leaving the hospital for the morning, enjoy the fresh morning air with a quick run! There were mornings where we were so tired and head hurting, wanted to do nothing more than go right to bed. That's what having the accountability friend is for... make you go for the run anyways, and like magic the headache goes away, the fog in the brain clears, and life is better again!

Much Love!

Estoy triste.

He had flown off his motorcycle and been impaled on a guardrail in such a way that it entered through the chest gone past the diaphragm into the abdomen and transacted bowel. I saw him everyday for a month, the vast majority of which he was in the ICU and unconscious. There were multiple wounds, both from the chest and the abdomen. We were responsible for the chest wound, tubes and drains, which at one point were quite numerous. By the time the month had ended, and my rotation had ended, he was finally out of the ICU, tubes were out, drains were out and what remained was a nicely healing wound wrapped around his anterior and lateral chest. He was one of those rare trauma patients who was nice and a positive individual. Even after they had rotated off the service my students would tell me how they would go and visit him, just to say hi and see how he was doing. I thought it was cute, and encouraged it. I would have liked to go see him as well, but on nights, if I have time its usually at 2-3am and not really appropriate for a social visit. Then one day, my co-resident told me he was finally being discharged the following day, and... that he was mad at me. By sending that message to me, it was the type of message where he wasn't really mad, but at the same time was being honest that he would have appreciated the visit. I put it on my to do list that night, and then of course the night goes from hectic to crazy to worse. It finally ends, without a visit squeezed in and he is discharged.

I'm pretty sure I will always regret not getting to him to say goodbye and good luck that one last time.  Not only had he remembered me, but remembered me by name, and what I had helped him with. I can assure you that chest wound was not exactly minor, and taking care of it had caused him pain on more than one occasion. It was a pretty sick place that we had helped him navigate through, and it took a long time, but he made it. Those patient's see so many personnel during their time in the hospital, it is rather rare when we residents are actually remembered. Wish I could have granted him that simple request of a visit to say goodbye.

Much Love.

Estoy empezando cosas nuevas.

I read once that the job of the teacher is to help his/her students to surpass him/herself. Should that not happen. Shame on the student. And shame on the teacher.


Our current group of students finished their 8-wk surgery rotation this past week. I didn't interact with too many of them, but there were a few that rotated with me the month of July while I was on consults/Thoracic Surgery. Their last day, I saw one of them post the following instagram picture.  Calling themselves "Masters of the chest tube." I taught them that! My little students growing up so fast. Tear. Made me so proud!! :)

Much Love.

Estoy con capacidad de sentido común.

He said that he had been hit by a car. Flown up and over the car and on the way down his foot had hit a mailbox. Only trouble with that story... didn't fit with his injuries.
You can ask him again, and usually the story changes a bit each time, but despite the inconsistencies, he sticks to his story.  The mailbox is at fault.
So I document.. Subjective: Patient reports....
Objective: Foot smashed
I pulled the Ortho resident aside. One look at the foot and it was obvious it would never be the same again. Say I was in the jungle, and the same foot came to me. I would not have the tools nor the know-how to put it back together again. She assured me I wouldn't have to amputate, that with a good cleaning and monitoring, patient could potentially keep his foot. Granted, who knows how he would walk on it. And in the end, for a variety of reasons (infection, necrosis of the bone, etc) may have to end up amputating anyways.  #thinkingahead

Another, on a motorcycle, hit from behind, went flying forward. He came into our trauma bay screaming about his carotid. Every two seconds, would ask us if his carotid was okay. His carotid was okay. Ankle not so much. But no worries about the carotid. Had us all a little, thinking he was weird, but then just turns out this wasn't his first motorcycle accident. Last time he had almost died from a severed subclavian artery. Carotid. Subclavian. Close enough... i guess ;)

We've had a string of cute kids come by on our trauma assembly line, in addition to our nightly appendicitis.
For the past two nights I've seen little 1yr old kiddies having taken a tumble down a flight of stairs. The most recent, dad had kept him calm on the ambulance ride to the hospital by feeding him potato chips. Note to all parents: don't feed your kids while on your way to the hospital in an ambulance. Or better yet, don't let your 1yr olds play at the top of a flight of wooden stairs.
We had a kid crack his jaw by over-rotating a back flip on the trampoline and landing on the frame. He was actually asleep when we saw him. Waking him up I realized too late that I was standing right by his head, potential for unnecessary startling. But, instead of being scared by waking up in a strange place with a strange person looking down at you, he paused a second and then smiled and waved up at us. We enjoyed his wit and one-liners interjected between our commands to 'move this' or 'move that'.
We had another kid with a broken leg. But he wasn't seeing us because of his broken leg. No, that was old news. He was seeing us, because despite his full leg cast he was out riding ATVs and falling off them. This poor kid was so brave, which I didn't see initially. He was happy and making jokes when we first assessed him. But later, after returning from CT imaging, Mom had stepped away to charge her phone, and not seeing anyone had scared him. I had returned to follow up at that point and caught the tail end of his tears.
Then the other day, I got to meet the next Broadway star. At least, that's his next goal. He's spent his summer practicing 6hrs a day. He was very excited at the idea of spending the rest of his summer on the couch watching Netflix though. I have no doubt we'll see him on Broadway some day! Super smart kid, and super interested about his appendix. I told him, that when he retires from dancing he should go to medical school.

Much Love.

Estoy confundida.

It's raining!! So exciting! I love the rain! It's simply fabulous! Best thing since sliced bread! Like nooooooo joke! Dead serious! It's amazing!


Don't let the plethora of exclamation points fool you. We really do like the rain. 'We', being the unnamed faceless workers along the trauma factory line. For some reason, rain brings a sudden miraculous increase in the intelligence of the human race. They don't go out on an ATV without protective gear and attempt to play with cars. They don't climb trees, work on roofs or jump off bridges. They pay attention when they drive, or they just don't even go out at all.  They drink, but at home, on their couches, while watching Netflix.


Despite, this typical observed increase in the human capacity for reason, five traumas rolled into our trauma bays throughout the night. More than usual for a rainy night, but I can't complain as they were for the most part stable and two actually even went home.

Wishing you a lovely rainy weekend!
Much Love.

Estoy contemplando cual es peor.

August came, and with it I have transitioned to night float. Somehow, it seems much more difficult to balance work and life outside of work when one is awake all night.  I mean... it has taken me three days to even finish this post. Perhaps, it is just me, and the fact that I am not a fan of working the night shift. Whine aside, I am thankful the month seems to be moving quickly.

In America, the general population very commonly has multiple medical problems. As a whole, we don't take very good care of ourselves. One way to avoid this problem, is to never go to the doctor.  We see it once in awhile. 55+ year old individual who comes to the hospital reporting no past medical history, but at the same time hasn't been to see a doctor in over 30 years. Guess what... they're not as healthy as they believe themselves to be. Far from it usually. And in accordance with their stubbornness, the reason for finally bringing them to the hospital has typically already been festering and ignored for weeks.

We had an individual come to us the other night after finally being forced to present to the hospital by his sister. Complaint was three weeks of abdominal pain. Upon further investigation, as I'm sure you've guessed, the story was so much bigger.

We found an 8cm abdominal aortic aneurysm threatening to burst with each bounding pulsation. We also found a 10cm mass overtaking his lung. He confessed he'd quit smoking on his way to the hospital. Too little. Too late.

Options were presented to him.
1) Just a guesstimate, life expectancy of maximum 6months from what was almost certainly lung cancer.
2) Possible sudden death at any unpredictable time from a ruptured abdominal aortic aneurysm.
3) Repair of the AAA, preventing possible sudden death, but taking on the risk of surgery which includes bleeding, infection, respiratory failure requiring intubation unknown ability to extubate, paralysis of lower extremities, kidney failure, and of course death... just to name a few.  And should he even recover, then still with a 6month life expectancy.
4) Do nothing, and let nature take its course.

He couldn't give us an answer that night. We didn't blame him.

What would you do?

Much love.

Estoy corriendo.

Given that I covered call last Sunday and going straight into call this Saturday, under ACGME rules I am allotted a 24 hr period off. Happened to be today. Upon waking this AM, I grabbed my phone to 1) check the time and then 2) check the weather. Wasn't supposed to rain until 2pm. Good, I thought. Plenty of time to work inside a while and get out for a run before it rains. When I finally stepped out of my building, unwinding my trusty old mp3 player, I immediately felt the small pings of raindrops. Sure enough, I'd had one deadline for the day, and I'd missed it. I'm trying to be better about getting out when I have the opportunity so I took the run anyways. Glad I did, as the rain stayed light and kept me cool. I pretty much studied the rest of the day. Made food and a co-resident came and studied with me when she got off work. We try to learn by taking the disease process, or symptom or sequelea all the way down to the pathophysiology. By understanding the why, making the result much more clear. We keep hitting road blocks though. All the cellular pathways and mechanisms we crammed into our brains back in med school seem to be half-erased leaving just lines, boxes and inert shapes which lend to recognition, but without reason. Might as well just have brains filled with legos; could actually build something with that. We eventually get around our road blocks and keep plodding on. I'd had other goals for the day as well, but just like my rain deadline, I've gone too late. Will have to save them for the next time.

Much Love.

Estoy respirando.

While I carry the consult pager this month, I also have my primary patients to take care of on the Thoracic Surgery service. One such patient kind of reminds us all of a flower child. I'm almost tempted to say that he can actually pull off his mullet, the one and only capable, but then... let's not get carried away.  He's always cracking jokes, so he gets along well with everyone. Even in pain he's making jokes. Due to all the past surgery on his belly, he had come to us (Thoracic surgery) as a last option. What would typically be done through the belly, we instead opened the side of the chest and got access that way. His lungs are just taking their time remembering how to be lungs again, instead of shriveled sponges. We've put chest tubes in. Taken them out. And then put them back in again. His pain doesn't help either. I dosed his narcotics so high, it would have been enough to completely halt my respiratory drive, but turns out...wasn't even enough for him. It's the first time I've ever seen someone's arterial blood gas actually improve by increasing narcotics.

And then on the consult side of things, we got another breast cancer gone far too long and literally eating away at the poor lady's chest. It's horrifying. Professional on the outside, screaming on the inside I continued with the interview. How did you go to work everyday? "I just put gauze on it, I thought it would go away." On exam I ask her if she's having pain. While squeezing her eyes tight and holding her breath, she tries to be brave,"no, that's not bad."
Honey, that's not bravery... that's denial.

Much Love.

Estoy enseñando.

As consult resident for the surgical service, I get called on average 3-10 consults daily. But of course, there's always the exception. Today was one of those exceptions, not only did I not get any consults, but the 0298 didn't even go off after 12:00. I ignored it, and kept busy, so as to not jinx the situation. For the second you acknowledge the state of calm, the pager will go off with minimum three consults in a row. Literally, the second. From my perspective, it's always a welcome break from the typical hurried hecticness. Unfortunately, I currently have three students assigned to my team. One sub-intern, and two 3rd years just starting their clinical year (brand new babies!). And with days like today they don't get to see all the amazingness that surgery can be.  We spent time going over past consults. An esophagus, completely structured shut after being burned with oven cleaner. Do we take it out and pull up the stomach? Can we even use the stomach? Should we interpose colon in its place, and does that mean the voice box has to go too?  A breast cancer beyond control, infected and eating away at the patient's chest. More discussion on patient denial there, than actual treatment of breast cancer itself.  That's one good thing about medicine, there's no end to topics for study, and we've kept busy despite no consults today. The students haven't complained yet.

Much Love.

Estoy recuperando.

Back to the crazy 24 hr calls in the ED on summer weekends. By morning, you're probably walking around with you head tilted to one side. Simply because, you're just too exhausted to get it all the way up straight. No sooner than you finally make it home the next day and you've crashed on the nearest flat place that can hold your body habitus.  Which then in turn, leads to a considerable amount of confusion when something wakes you mid-afternoon and you have no idea where you are nor what just happened!!

The human body never ceases to amaze me. The other day I saw someone walking down the hall, scratching her head and talking on her phone. You could tell she was part of a family, and as they were all solemn-faced standing outside of the MICU (and it had been the third time that day I'd seen them), one could only conclude they were there to say good-bye to a loved one. And I as struck with amazement. They were saying good-bye to someone, yet no thought to themselves. Someone they loved had stopped breathing, heart stopped beating and eyes stopped seeing. Yet she was talking on her phone, with no thought to her next breath. Beholding her family, with no thought to when she would see them last. And heart hurting, with what belief about eternity?

Our Creator in His divinity has made it pretty easy for us. Our bodies pretty much take care of themselves. Breaks down and builds up; heals itself where needed and when allowed. Then just like our relationship with the Creator itself, we can go mess it up pretty bad sometimes.  Seemingly, to the point of irrevocability sometimes.  But the awesomeness of God's creation can not be limited to science, and without our understanding it survives and healing is provided. The body could never hope to be the same again, nor should it be. It now holds a beautiful story instead. Healing and hope. Same for a relationship with our Creator, once broken and repaired against all odds, carries a story of glory unlike any other.

Much Love.

Estoy celebrando.

Happy 4th of July! Literally ran out of the hospital yesterday, just in time to jump into a carpool with some of my co-residents. We were off to see some fireworks. We sat packed in like sardines facing towards Kensico Dam and watched with wonder as the flashes of light dazzled us, and the deafening sound reverberated within our chests.

 Danny, me, Monica, Min Li

Luke 12:48  "...For unto whomsoever much is given, of him shall be much required: and to whom men have commited much, of him they will ask the more."

For the most part, my life in residency is fairly constant. Nothing new really to report. I did, however, recently move. Have an apartment on the hospital campus now. Weird to be so close to work, but invaluable to not have to worry about driving in snow during the winter. Definite blessing.
Furthermore, I'm back to being a 2nd year again. It's hard to watch as the seniors struggle with teaching all the brand new interns. It's tough, knowing you could do the work three times quicker and correctly, to stop yourself... and leave the work undone waiting for the intern. They have to learn how to manage, correctly and efficiently. How to prioritize and make their own check-lists. We don't remember it... but we were all there at one point.
I'm still trying to figure out what kind of chief I want to be some day. I have no doubt, I'll never actually succeed in deciding, but instead will just have to walk the walk one day. Praying for God's guidance with each step.

Much Love.

Estoy contenta.

On call the other weekend, I got a call about a liver transplant. The recipient had arrived to the hospital and needed his admission taken care of. I recognized the patient's name, wasn't sure where from, but figured he was a chronic patient due to his liver disease and so had probably taken care of him at one point. Even talking with him, I didn't quite recognize his face. Just couldn't figure it out. Then I started going through his medical records and past operative reports. Light bulb! That surgery! now that I remembered in detail! Still couldn't quite remember the patient, but couldn't forget the surgery!

This month, the longest of the past 12, has finally come to a close. And with it, the end of Intern Year 2.0. Thank goodness! I propose a toast. Cheers! To never being an intern again!

The surgery program at Westchester has undergone immense change this past year. We had seven Attendings leave. Seven teachers. Seven mentors. Seven friends.  In a way, it hurts to see so many that I hold in respect move on. I want them to stay and teach me! Furthermore, the empty space left in their absence creates instability and uncertainty. New Attendings are slowly being hired, and they are excellent. But requires even more flexibility and adaptation. It's not an ideal situation for us surgery residents. Hard to build on a cracked foundation.

As brand new interns start tomorrow, July 1st, there will be even further change, as our resident roles themselves will have to shift to accommodate different numbers of residents. For example, next year instead of eight 2nd year residents, there will only be six of us... to fill the role of eight?  So, not sure how it'll all play out, we go forward. Willing to work and Ready to learn.

Much Love.

Romans 8:38-39

³⁸ For I am persuaded, that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come,
³⁹ Nor height, nor depth, nor any other creature, shall be able to separate us from the love of God, which is in Christ Jesus our Lord.

Estoy casi al fin.

There's always a moment of of subconscious pause each morning when you pick up your list. What was the damage done overnight? Breath held waiting for the result, is released in one of two ways 1) relief  2) sigh. This summer is proving to be full of trauma. Drug deals gone bad. Hate crimes. And then of course the typical array of motor vehicle collisions and people falling down. My held breath tends to be released with a sigh every morning. Six new names. Seven new names. Only three new names!!  It's even more difficult in my position when the ICUs unload their patients to the floors overnight to make room for all the new admits. My job, to pick up where the ICU left off for those patients. Sigh. It's like Westchester turns into a Trauma factory during the summer. They just keep coming in, and its all I can do to keep them going out at the same rate. If I don't, we drown. It can be stressful. Take today for instance. Two of my discharges were ready to go when I saw them at 6am. But we rounded, then morning report, then rounding with one attending (during which they reminded me they were ready to go), then I had a case, then rounding with the second attending (they were still waiting) and I finally got to sit down at a computer and my co-resident texted me, "Is there clinic today?" I was already 10 minutes late, and clinic was clear across campus. I walked there at the typical brisk pace of someone with somewhere to be... my head hung down. I try so hard, I don't let a minute be wasted. All my notes written by the time morning report is finished. Morning orders in by the time of rounds. Consults called. Dressings changed. Touch base with social work, case management and physical therapy. (Make sure they take care of your patients first ;) While anesthesia is intubating get through as much paperwork as possible on the OR computer. But, you just can't physically do it all. Clinic will take minimum three hours and your lovely patients who were ready to go at 6am, were fully dressed by 9am, will still be sitting there at 4pm, just waiting.  And they look at you like, "why?" FAIL.

Believe it or not, my chief actually helped me out today. Took care of the easy discharges. Then inbetween patients over at clinic, I was able to log on and complete the work for a few others.  And then after all that... at the end of the day... the list is still just as long. Sigh.

Much Love.