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.