Estoy trabajando.

Every morning I enter his room. He somehow was lucky enough to have the corner room, stuck back far down the hallway from the nurse's station. If any place on a hospital floor could be considered "quiet", that just might be the closest thing. And that's where he has been, day-in and day-out. The living epitome of "convalesence", in the slow and disheartening sense of the word.
I wake him up. He cracks an eyelid, confirming what he already knows. It's just me. And he sticks his tongue out at me. His santa hat had fallen off at some point during the night. I ask him if I can put it back on. Without saying anything, he holds his head forward for me to replace his night cap. I ask him if I can check his wound.  He doesn't say yes, he says... "why don't you check my wound." And so it goes, every morning. And I wouldn't have it any other way. Anything less, and I would worry. He already has me worried enough. He doesn't want to eat. I've given him more than one lecture about the importance of his nutrition, the whole while he just quietly stares at me like a defiant two-year-old. Not about to verbally defy his doctor, but when his dinner tray comes, he then throws his supplement shakes on the floor. What more can one do?

Tonight is New Year's Eve. The end of another year, and as I look back on 2018... I'm tired. I'm sure this is impacted by my last month as acting chief resident of the Vascular team. Where everyday anyone of your patient's could code and try to die on you. Sometimes, for no good reason at all, speaking from experience. And therefore, you stay as sharp as possible looking for anything out of the ordinary. Is his heart rate faster today?  Is his magnesium too low today?  Did he not stick out his tongue at me today?  Every little thing matters.

I wish I could make him better. I wish I could get him to eat. I wish I could help them all. In the meantime, I'll keep trying nonetheless.

It's not about being tired, exhausted even. It's not about me. It's about being right here, where I'm supposed to be, and allowing God to build me into the vessel for which he has a use. I will get up extra early tomorrow. Prepare extra for my call. And hold my breath while I wake him up, waiting for him to crack his eyelid and stick out his tongue.

I wish everyone warm feelings and congratulations for passing another year of our Lord.  May prosperity, happiness and health be yours in 2019. God Bless!

Much Love.


I will lift up mine eyes unto the hills, from whence cometh my help.  My help cometh from the Lord, which made heaven and earth. He will not suffer thy foot to be moved: he that keepeth thee will not slumber. The Lord is thy keeper: the Lord is thy shade upon thy right hand.  The sun shall not smite thee by day, nor the moon by night.  The L:ord shall preserve thee from all evil: he shall preserve thy soul.  The Lord shall preserve thy going out and thy coming in from this time forth, and even for evermore. Psalm 121

Estoy celebrando el nacimiento del Rey de Reyes

“Porque un niño nos es nacido, hijo nos es dado; y el principado sobre su hombro: y llamaráse su nombre Admirable, Consejero, Dios fuerte, Padre eterno, Príncipe de paz.”
“For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace.”

When given the option of Christmas vs. New Year’s, there is no difficulty choosing a holiday to have away from the hospital. In general, our Jewish colleagues hold down the fort while the rest of us pause to celebrate Christmas and then we swap for New Years. Usually everyone comes away happy, perhaps some hard feelings about working Christmas Eve, understandably so.

Reality speaking, working Christmas isn’t the end of the world. Done that before, and I’m sure will do so many times in the future. It just means that I have a job. Many are not so blessed.

Family plays an important role around the holidays. You can walk down any street in America this time of year and find all levels of crazy gathering together. Everything from the single working individual sharing a midnight bone with their animal, to the well-lit and overflowing house operating at all octaves and speeds humanly possible, and.. well.. unhumanly possible I imagine. Perhaps, the parties involved in either situation secretly wishing for the opposite scenario for themselves.  I myself, being far from immediate family, am able to claim my third cousins, who live two hours away, as my family. They’re more than just third cousins though, and it is through our willingness to profess belief in Jesus as the Son of God and Man that brings us together as family.

Whereever December 25th finds me, Illinois, New York, or Timbuktu, whether by myself or with others, I am never alone. And everyday is Christmas. 

I didn’t have the time to get together a Christmas card this year. But as to celebrating the birth, life and death of Jesus my brother, friend and Savior, I wish you all A Very Merry Christmas!

Much Love.

Estoy esperando.

Research day was this past week, Wednesday to be exact. I had dutifully put together an abstract at the second to last minute as is required of us and submitted it. It was accepted for a 3 minute presentation so I picked out some pictures to illustrate the subject and my argument and strung together enough words to equal those 3 minutes.

My Attending stopped me as I was then running out the door to catch the shuttle to go back to the hospital and operate. “What questions did they ask?” He inquired. “None!” I responded. They were more worried about getting on with the next 3 minute presentation, than to wonder at anything I had to offer or say.

I’m just glad it’s over again for another year. Needless to say, research is not exactly my cup of tea.

Much Love.

Estoy limpiando la arteria carotida.

I have often been asked, "What is your favorite surgery?"

I never really had an answer before, and gave some sort of response along the lines of, "I like them all!" I know, I know... eye roll with a side of cliché.  But it was true.

Not anymore!  I love the Carotid Endarterectomy! It is a very sophisticated surgery, and as Dr. Babu says, "It must be done technically perfect." In other words, the stakes are high. But that being said, a very nice Carotid can be completed in an hour or so, depending on the dissection required and if shunting is required. Sometimes 2 - 2 1/2 hours. Not bad for a really beautiful surgery. 

I stayed post call at the hospital this morning to do a Carotid with the Master, Dr. Babu. I'd probably stay post call to do any case with Dr. Babu, but a Carotid... wild horses couldn't keep me away from that. 

Here are a few of my Carotids thus far in residency. The one from this morning is there on top. The plaque extended much further than we were expecting based on the preop imaging requiring us to extend our arteriotomy along the artery both proximally and distally. We eventually just had to say enough, because we could have just kept on going. It delightfully left me with quite an impressive arteriotomy to patch up at the end. Really nice case. And at the end, Dr. Babu thanked me for staying and I thanked Dr. Babu for the opportunity to learn from his technical perfection and improve on my own.

The Carotid Endarterectomy

Much Love.

España

Some time ago my co-worker and I were talking. Not really surprising, we talk often. But this particular time we were expressing our shame for never having taken the time to visit Spain. We resolved to plan a visit together. So then, when our next year's schedule came out and we discovered we had been assigned to the same vacation time at the end of November, we took action on our resolve and planned a trip to Spain.

We arrived in Barcelona right as the sun was starting to rise and took a bus into the city. We found our hostel and asked to store our backpacks, which they obliged. We then took off on foot to explore.

 

Wall art at our hostel. A caricature of Barcelona.  

 A street, a sidewalk, a bike path?.... sometimes, we just couldn't tell which was which.

 I was surprised at the focus on running, exercise and yoga that we found. Walking around Barcelona that Sunday morning we came across not just one, but many races that were underway. At the same time, when looking around, you'd be hard pressed to find anyone overweight, so I guess that goes hand in hand.

 Through the alleyways, alongside the cathedrals.

 Cristóbal Colón standing guard at the port. 

View of the city and port from Montjuic.

 Cafe and tapas.

 Becoming acquainted with Gaudi. Casa Batlló

 

 Monica, Maria and I at La Sagrada Família

 La Sagrada Família

 Gaudi designed La Sagrada Família playing to the strengths of light and color.

 La Sagrada Família

 The setting sun expressing itself via the stained glass of La Sagrada Família.

 View from the passion facade of La Sagrada Família.

 Barcelona

From Barcelona we rented a small Peugeot and I had real-live refresher on manuel driving as I maneuvered us out of the city and North for Monserrat. 

 Montserrat

 There is the option to drive up to the Monastery at Monserrat, but then miss these amazing views?!?! We took the short hike up to the Monastery. Best decision!

 Montserrat

 Montserrat

 Montserrat = serrated mountain

 The basilica at the Monastery is absolutely beautiful. We did pass by the Black Madonna.

 

 a memorable evening in Tarragona

 stopping at the market in Valencia

 The market at Valencia

market at Valencia

And don't think we left without paella valenciana. We definitely had paella valenciana. ;)

We made it to Xàbia by sunset. The coves along the coast used to be shelter for pirates and smugglers. 

Monica and Maria waited for me as I ran down to and along the coves searching for pirates! Got close enough that my shoes definitely got soaked with the Mediterranean.

 Cala Blanca

Twilight at Xàbia

Breakfast along the Spanish Mediterranean coast before heading off and into Andalusia.

Granada, off to explore Moorish castles and gardens.

 

The Alhambra

Detail of the Alhambra

Gardens of the Alhambra

 Palace of Carlos V

From the top of Torre de la Vela, military area (Alcazaba) at the Alhambra

The Alhambra

Gardens of San Fransisco at the Alhambra

Pausing along the Palace of Carlos V

 Granada

 I think I could fly.

 mountains of Andalusia surrounding Granada.

Ronda, another of the small white towns of Spain within Andalusia.

 from the bottom of El Tajo gorge looking up at Puente Nuevo in Ronda

Climbing up the gorge we came across an old abandoned house

It was perfect for the imagination, just missing the fairies.

Monica, Maria and I hiking El Tajo Gorge

 Overlook from Ronda

 Overlook from Ronda

Honestly, I think I found where I will one day retire.

 Maybe he can be my neighbor!

 One last look at El Puente Nuevo!

 Sevilla, Spain and perusing the stalls at the Bethlehem Fair outside of the Cathedral.

Sevilla 

 Cathedral at Sevilla

 Plaza de España!  Could be from another world!

 Plaza de España! 

 Plaza de España! Trying to catch the rainbows in the fountain.

 Plaza de España! 

Plaza de España! 

 Plaza de España! 

 A place to sit. A story to share.

 The gardens at Real Alcazar in Sevilla

 The gardens at Real Alcazar in Sevilla

 The mosque-cathedral in Cordoba. The quickest drive-by visit ever!

We made it full circle in one piece, both us and the car.

One last walk down Las Ramblas in Barcelona. 

Much Love.