Estoy tomando mis vitaminas.

“Take your vitamins!” “Drink your milk!” What household across the United States are these common phrases not spoken? Probably quite few, we are a first world country after all. They came as Flintstones in our house. Mom saw that we got our square meals, and we never went hungry. Were supplements really necessary? Probably not, food pyramid bases were more than covered, but once a day we ate our vitamin nonetheless, whether Dino, pebbles or Wilma.  And now here we all are, all grown up big and strong. Healthy.

Places like West Africa, Thailand, Nepal, refugee camps and local areas where food staples consist of rice, rice and more rice there is a very different story, than the one I can share. There are no square meals, there is always hunger, and here, where supplements would be most needed, there are none. Malnutrition, a common cause of disease, plagues the population. These rice subsisting communities are frequently vitamin deficient. One such vitamin is B1, or Thiamine. Clinical signs and symptoms of Thiamine deficiency originate from the Cardiovascular system, GI system, and perhaps the most severe forms affect the nervous system. Ultimately, if left untreated, it can result in death. 

So why am I talking about vitamins? Who would be vitamin deficient in the US? Well, alcoholics for one, but I don’t want to talk about that now. I am currently on the Minimally Invasive Service. It’s an efficient service, with excellent Attendings. I enjoy learning from each of them, and hope my laparoscopic skills can one day be enough to rival theirs. Our service is heavily a Bariatric Surgery service. This is another subset of the population in which you will frequently see vitamin deficiencies, Thiamine included. In fact, it’s a serious enough possibility, that every post op patient we see needs to have their levels checked. The patient could be in the ED having stubbed his/her toe, and yet my attending is going to want to know the vitamin levels before paying the poor toe any mind. 

I can not rectify in my mind the vast difference between the above two etiologies of Thiamine deficiency. We live in a world where there is so so much we electively choose to alter our bodies in order to create a situation that reflects a world of so so little. 

We recently had on our service a patient that came to us from another country where she had undergone Bariatric surgery. The surgery had been complicated, and thinking that she could potentially die, she had flown home and came directly to our hospital. If she was to die, she had wanted to die in the US. The saddest part of this story, is that the patient was not obese, based on her BMI, she wasn’t even over-weight. She had just wanted to be a few pounds lighter. The surgeon should have told her she was beautiful, advised to stay away from the midnight ice cream snacks, and sent her on her way. 

I have heard the success stories after Bariatric surgery. I’ve seen them as well, and rejoice with the patients essentially cured of their diabetes and aching knees, etc. But despite that, I can not and will not ever recommend Bariatric surgery to anyone. 

Much Love.

Estoy parte de un terremoto.

The World Cup is over. The majority of those around me missed it. France won, in case you missed it as well.

A month ago, when the first games were underway, I’d excitedly ask random people in the hospital their opinion. You know, pass the time while waiting for the trauma to role through the doors, or the CT scan to finish on a patient, etc. The general response I received was, “Is the US playing?” No. “Oh, well, then I don’t care.”
Their response so strikingly American, and it makes me sad. The whole world cares about the World Cup! We all live in this world together, share the same sun, the same moon and stars, why not care together as well.

An American soccer player publicly expressed his support for Mexico during the World Cup and received quite a bit of backlash for his support. Also makes me so sad. If we can’t support our neighbors in something as meaningless as a game... how can we claim being neighbors at all?

I did not get to watch any of the games myself, but I did have the app open on my phone waiting for the updates. When all of Mexico jumped during their first match against Germany, registering seismic activity on the Richter scale, I jumped with them.

Common sense 101 on relationships teaches us to find common ground. Show interest in what someone else cares about. Find similar interests you can relate with each other. It’s all building up and out from there. When the whole world comes together around a single issue, I want to be a part. I want to share in their joy and sadness. I want to build a relationship.

Much Love.

Estoy siéndome como una esponja.

A sponge, is how I can describe it. You must be a sponge to survive. Soak up the sleep when the opportunity presents itself. I feel like I am barely able to soak it up in time for my next call; when I’m wrung out dry once again.

When discussions were afloat about scheduling changes for this year, especially concerning night float, hot topic was who would present the following morning at morning report. When a night float was in existence the senior resident presented all events from overnight the following morning. All ex-patriots of that position expressed utmost importance for that role to remain in the charge of the pgy3, or ER senior on call. Having stood next to multiple of my seniors as they stood up to present I knew what it would entail, that does not however, make it any easier.

It’s like standing up in front of a firing squad. Nothing to hide behind. And no where to run. Every decision made over night, whether you actually made it or not, is your responsibility, and up for target practice. And you’re standing there, awake for 26+ hours at that point, ready to take it like a champ... or not. Taking responsibility of the surgical service of a large academic hospital is like conducting an enormous orchestra, so enormous it overflows into 5, or 16 or 22 different rooms, and yet you have to somehow figure out to keep everyone on time to the same beat, in key, and of course alive. Sound nigh impossible? Kind of, yea. But you’ll be asked about it the next morning, and so you try your best anyways.

So when the intern texts with another concern or question you respond immediately no matter how minuscule the issue, because you yourself can not physically be on the floor addressing every single Tylenol renewal the nurses need, and are therefore reliant on your intern escalating anything and everything out of their scope. Especially now, at the beginning of the year, an intern going rouge, off on their own beat, is the last thing you need.

Some morning reports are less painful than others. A strong and dependable on call team helps. A chief resident who is willing to help, and/or do cases overnight helps. And having some time in the morning to gather your notes and try to decipher your scribbles from overnight and remember what actually happened also helps. But whether you have those helps or no, you’re still wrung dry.

Here’s to surviving yet another senior call at the Chester.
Much Love.

Estoy tratando entender.

He was brought in with the appropriately appointed guards. Two of them, like always, one for each side. The presenting story was an assault. He had been pushed down a flight of steps and landed on the throat. He felt his neck was swollen and that his voice was sounding on the side of duck-ish. Trauma was activated and the patient was seen and assessed. Incidental finding of metallic objects in his stomach on Xray imaging.

Yes, please tell me you had a question mark floating after that last sentence. But it’s true. Razor blade will be wrapped in plastic or rubber and swallowed. Relatively harmless to the inmate, but once discovered, a ticket out. “Vacation”

As much as I have learned in this life, I’m still a small-town girl from the mid-west at the root. From time to time, I’m met with a new encounter that I am not able to empathize or relate to. Is that a good thing? Bad thing? Whether I understand their reasons or not, I can at least control how I respond to them. For whatever the reasons, covered in rubber or bare razor, it’s unsafe to leave sitting in one’s stomach.

I hope that I continue to learn from this world, improve my ability to form relationships based on common ground, and then eventually build on that relation.

Meanwhile, down the hallway, she was recovered and ready for discharge. She would suffer pseudoseizures when it was time to leave. Eventually we had to just let her go out the door and voila, pseudoseizure spontaneously resolved.

Sometimes I wonder, and I ask again, my inability to empathize or relate at times… is it a good thing? A bad thing? 

Much Love.

Estoy practicando respirar

It’s true poetic justice when your own human weakness proves your own vincibility. I had just about made it. Made it out of my month of trauma, my month of long hours and no sleep. I had kept it up, thought I could get away with it. Started believing my own invincibility. Believed it to the point that I ignored the sore throat that had started gnawing throughout the day last Friday. Believed it, until I woke up June 30th undeniably sick. Beyond the help of gummy vitamins.

I still go to work. We are residents, it’s what we do. It’s not an uncommon site to see a resident who is sicker than their patients. Plus, July 1... Had to be there for that. All hands on deck for the new interns.

I should have taken a hint when my intern asked to have July 1st off without giving a reason. I said no. He had gone to the chief residents and asked them not once, but twice. He had again been told no, twice. I had both emailed a list of expectations, and spoke to him on the phone how July 1st was to play out. Efforts which proved to be in vain, when I showed up to the 4th floor residents lounge July 1 ready to meet with him and round, instead was told by the night intern that my intern had yet to show up for the day, nor had he gotten any sign out on our patients. I’ll summarize and say we had a rough start. Nice welcome to being a senior surgical resident for me. *Note sarcasim* Got to teach him the importance of 1) being where you’re supposed to be   2) when you’re supposed to be there, and.  3) prepared to do what needs to be done.

July 1 was followed by July 2 and the start of our program’s new call schedule. No longer will we be having months of night float. We’ve switched to a 24 hour call schedule and I was up first for 24hr senior call. By this time, the virus that had started blossoming a few days prior had taken up residency in my lungs making me feel like I couldn’t breathe and my voice was half gollum, half squeaky  church mouse.

I didn’t even try to be productive when I finally got home from call. I went to bed with no plan to get out of it again until work the next day if possible. My lungs still feel like they don’t want to breathe, but I make’um anyways. Hopefully a little bit better each day. And my intern will be just fine as well. You could see that he knew he had messed up. I can work with that.  We’re all going to be just fine.

Much Love.