Estoy emocionada.

One more night! One last night! Then I'm freeeeeeeeeeee! (yes, that was sung at a screechy high C).
We've had the whole spectrum over the past four weeks. Busy nights. Slow nights. Crazy-trauma nights. Inundated-with-pediatric-patients nights, crashing-patients-in-the-ICU nights. Nights where I've already reached my eye-roll quota by 8pm. Nights where the Attending buys us dinner. Nights where we don't even get to pause for our coffee until its at least 4am.

It came out in casual conversation last week that one of our med students played the violin. It took minimal coaxing to get her to bring it in, and the following night we stole away as soon as we could for an impromptu concert. We would give a song and she would play it. We gave off some rather random songs, and it became easier to play the song and she would then accompany it. It was really fun!


With February done, next up is vacation! Getting ready to get a move on!!

Much Love.

Estoy enamorada.

I have always loved posting for Valentine's Day. Looking back, I realize that I have definitely overused the title of “Estoy enamorada,” too late to correct that now, might as well just embrace it. hehe



I was expressing my excitement for Valentine’s Day to a few friends, and was surprised to receive rather adverse reactions in return.  I suppose I shouldn’t be surprised, the occasion does tend to create a wide range of unique opinions regardless of background, age, or relationship status. Arguments against draw on the commercialism edge from Hallmark as excessive or, the number one argument I hear… we should love every day, not just one.



I’m sad when I hear those reasons. Valentine’s Day is not giving us a reason to love. It is simply celebrating love we already have. In this world where destruction, hurt and ugliness fill our headlines, why voluntarily veto a day that celebrates love? A day that promotes sending hearts and flowers instead of punches or bombs. A day that makes it socially acceptable to go around giving out hugs and kisses. Even if just for a day. When it happens one day, then it can happen another, and another, and another.
I actually came across a few anonymous comments online the other day, and thought that a few were quite well put.

"I love Valentine's Day, and I've never celebrated it with a boyfriend — actually, I've dumped two boyfriends on Valentine's day, so maybe I do celebrate. It's a day when we're allowed to express our love, which isn't to say that we shouldn't express our love everyday. I just think some people need permission to give love, and that should be okay. I love that there are 24 hours every year dedicated purely to love. I use Valentine's Day as an opportunity to make tacky cards for my best friends, my sisters, my parents, my coworkers, etc. I make lists of their greatest attributes, fondly recall obscure memories in long, rambling postcards, or sometimes, I'll just stick to love ballads. In general, holidays shouldn't be about what we don't have. It's easy to gripe about the love we've lost, looking around at happy couples drinking wine. But what if we celebrated all the love we had? Wouldn't that be fun? Wouldn't that be lovely?"

"I …. love Valentine's Day. I think it's one of the happiest days of the year. Even if you're single and say that it's a made up holiday, it's made up to celebrate love, which is like, the best thing in the world. You don't have to be in love, but there must be someone you love, like a parent, sister, or friend. So why not have a day to remind you of how special those people are? Plus, red wine and chocolate? Duh."

We don't get much opportunity for expression as scrub clad surgery residents, but we find a way. ;)

I LOVE YOU!     HAPPY VALENTINE'S DAY!

Estoy desilusionada.

This is a story of modern American medicine. You can take from it what you will. Good or bad, it’s reality. From it I am trying to weed through and decipher what lessons to take home. 

Nine year old female, has strep throat. A few days later she develops nausea and vomiting. Really unable to keep anything down. Then she develops lower abdominal pain and at some point starts having diarrhea, and intermittent fevers are reported. Mom takes daughter to urgent care. They send her to the Emergency department concerned about her gallbladder. On presentation lab work is obtained, her white count is normal and her CRP is barely a smidge elevated (inflammation markers). Based on lower abdominal pain rather than upper, ED requests imaging concerned more for appendicitis. An MRI of the pelvis is obtained which shows a normal appearing air-filled appendix. Without an answer for mom and dad, they proceed with obtaining a CT scan of the abdomen and pelvis. Once again not only is a normal appearing air-filled appendix appreciated but the study is actually negative for any sign of inflammation in the abdomen or pelvis. The patient is sent home with no answers for mom or dad. Unfortunately the child’s abdominal pain persists. Mom takes her to their family doc, and an ultrasound is obtained, negative findings. Mom obtains a meeting with a Gastroenterologist, who listens for a half second, hears that the girl has pain in her right lower quadrant and sends her back to the Emergency Department telling mom it has to be appendicitis. Girl and mom present back to the ED for reevaluation as instructed. On presentation lab work is obtained. Her inflammatory marker of white count is once again normal and her CRP is now also within normal limits. An MRI of the pelvis is obtained, again showing a normal appearing air-filled appendix, negative appendicitis. This little girl is admitted to the hospital, still with no diagnosis. At this point the patient is no longer nauseous or vomiting, actually is able to tolerate a regular diet, pears and pasta to be exact. Her diarrhea has resolved and bowel function returned to normal. Her fevers have also abated. Yet she still cries about an abdominal pain that insists on persisting. Therefore, due to demands from the mother, surgery is consulted to “rule out appendicitis.”

In general and brief, there are three main modalities of diagnosis. 1) Clinical presentation 2) Lab work 3) Imaging.  In the United States we are blessed with all three, and with fairly easy access I might add. Around the world, that is not always the case. Perhaps a diagnosis of appendicitis is made based purely on clinical presentation and patient taken to the operating room. Does that mean a normal appendix is taken out from time to time? Yes. So when all three modalities are available and obtained, a case for or against appendicitis can be made with both incredibly high sensitivity and specificity. And, in the case described above the patient’s clinical presentation, lab work and imaging are all NOT consistent with acute appendicitis.

I then ask you, in a world where appendicitis can be diagnosed solely on clinical presentation, did this case justify 2 MRIs, 1 CT scan, and 2 ultrasounds? Did it justify repeated lab draws? And did it justify a surgical consultation?

Much Love.

Estoy elevando el listón.

What do you remember about your favorite teacher? Or perhaps a specific lesson you learned? How about a random experience you had with a teacher, good or bad?

On nights, a two person team is sometimes not enough. Recognizing when help is needed and eliciting available and appropriate resources is part of the job. So when an open laceration left over from the day team comes to our attention on an already busy night we do just that. Elicit the help of the sub-I doing an overnight rotation in the ICU. Seeing as it is now February, this sub-I has already applied, and interviewed for his surgery residency and is waiting till the fatal day in March when he finds out where the next five years of his life are to be consumed. Looking retrospectly, it was perhaps misplaced, but I had an expectation that someone a few months from their surgery residency would 1) be able to suture a lac and 2) even if they couldn’t, dive right in either way. So when I rattled off the short list of specific steps I was looking for, his hesitation and uncertainty, took me by surprise. Breaking it down, we isolated the specific step that was causing him this hesitation, and therefore we collectively decided he would perform all the steps up to that one, at which time he could text and I would return to demonstrate and assist. When that text came, and I headed back. I was expecting to need to place a stitch, then walk him through the second, and then be able to move on. I entered the room to instead find that nothing was even set up let alone any of the steps actually completed as we had agreed upon prior. I assessed this situation in one look, paused to take a deep breath, then took off my jacket and grabbed a pair of sterile gloves. It was a busy night, and I had no time for this. To be honest, I was disappointed. I worked quickly, explaining what I was seeing, what I was doing about it and why I was doing it. He nervously nodded and followed along as I went. His hesitation remained, and he didn’t actually don his own pair of sterile gloves until I hinted that they should have already been on if he had wanted to get any of the action. Flustered, he pulled on a pair, and hands shaking took the instruments from me. At one point the patient yelped in pain and he about jumped out of his skin, losing his place in the process. It was a slow and unsteady two stitches, but he finally got them with half assistance by myself. And we finally moved on to the next thing on the list for the night leaving behind specific instructions for a dressing and a “well done.”

I wonder the view-point of that sub-I. I walked away well aware that I had just half terrified him. Perhaps I should not have had such expectations. Perhaps it was a bad experience for him, maybe good. But either way, I just pray that he learned something. Time goes quickly, and before he knows it... he’ll be the intern. 

Much Love. 

 

 

Estoy cambiando la chamarra.

February! Month of Valentine's Day! I get to spread the hearts and hugs while back on night float at Westchester! Together with Monica again! We were asked if we planned and/or requested to be together again. We hadn't, but I celebrate the small blessings! Nights is difficult for me, and being able to attack them with a good team makes a world of difference!

We've renewed our goal from back in August to package up an appendicitis in 15minutes. Our best time then was 17minutes. We had four opportunities last night, but the night was too busy to be able to combine forces and we had to split them up. I'm sure we'll have many more opportunities before the month is up.

Our program got new jackets! My old jacket was getting frayed on the elbows, cuffs and seams, so it was nice of the program to provide a replacement. They've got our names this time. Fancy. Fancy.

You can look HERE for past jackets. ;)

Much Love.