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.