Estoy compartiendo mis pensamientos sobre la navidad.

This holiday season I have been mulling over the meaning it holds for me, for each of us, and for everyone else. Prompted in half by Hudson Taylor releasing their Christmas song "How I know its Christmas." and half by someone simply asking me that question. What does Christmas mean to you?

I love Christmas, and was troubled by the fact that I found I could not really pinpoint why. I was also troubled that, it could not be a blanket all-encompassing reason, as Christmas is celebrated nations around the world, and its meaning would be affected by cultures, family status, location, etc and then there are many that don't even celebrate the holiday. Which, that led me down a whole different rabbit hole, not the topic at the moment though.

I was blessed to be able to fly to Illinois for a weekend to celebrate with the family.

I was struck by the winter landscape flying into Bloomington airport. So different than the hilly landscape covered with trees, and homes of Westchester which I had just left. The love I have for the Midwest and this land can not be understood by simply visiting, as my love is strongly affected by nostalgia. The beauty I see in the prairie comes from stepping out for a run and having your path literally fade into your own horizon. The world is big and open and free here. And I was happy, and it was Christmas.



I thought about Home. Is "Home" what Christmas means to me? God has taught me a lot over the past decade about Home. He has broken me down and moved me around enough that "Home" is no longer tied to a specific location. He made real for me, the commonly quoted cheesy phrase of "Home is where the heart is." And, as long a Jesus is with me, I am home. So.... not home. Because flying to a specific place or being in the hospital or not does not alter what Christmas means to me.

I thought about family. But there again, is a concept, God has molded over the past decade. I spend the most amount of my time with my work family, try to steal as much time with my church family as possible and visit my immediate family whenever physically possible. But I dearly love each one, and no matter which family I am with over the holiday, Christmas means the same to me. So... not family either.

I thought about Jesus. Christmas celebrates the birth of Jesus. God born as a meek and lowly babe. I feel guilty, Yes, that is what Christmas should be to me. But of my 34 years, I have never really celebrated it as my Saviour's birthday party. So to claim it now would feel false and I would be ashamed of myself for not being honest. Significance maybe. The significance of Christmas to me is Christ's birth. Jesus made approachable to each of us even in our most weak and vulnerable state. But... I'm still stuck, what does that mean for me?

I went over the aspects of Christmastime, hoping to shed some clarity on my answer. Christmas caroling: singing for others especially home to home, spreading cheer, sharing love, letting those caroled to know that they are remembered and valued. Christmas lights: warmth and love and light where was previously cold darkness. Gift giving: desire to grant each others wishes and fill hearts with delight and happiness, an excuse to exhibit materially the love we feel for each other. The DrummerBoy: when there is no money for material gifts, he played his drum for him, he did his best for him, and he was loved for it. Christmas cookies: made not for oneself, but deliciousness to share with those you love. Wishing everyone a Merry Christmas: wanting to lift spirits and spread love and laughter to those around you.

I began to notice a common theme: it was Love. Of course it was Love. The answer to all of our questions, worries and wonderings. Is. Love. The world over, not bound by cultural barriers, the Love of Christmas is celebrated. Not limited by location, life situation, or company. Humanity uses the Christmas season to spend time with and remember those they love, share and give out of love, spread warmth and light and love to the world around them.

God is Love, and what better reason to celebrate Jesus birth, than to share and celebrate with others a Love so great that he gave his only begotten son as a baby for each and everyone of us.
This is what Christmas means to me. 

 

 A few pictures from my trip home to Illinois:

Peter Bear, Little Lincoln and Miles Austin ready to go swimming!!

Peter Bear with some intense Jenga focus.

There's more than one way to knock over a tower!

This makes me so happy!

Much Love.

Estoy presentando nuestra investigacion.

Our yearly research day was this past week. I dutifully put together an abstract for submission, and then was subsequently ecstatic when it was not accepted for presentation. It ment I would not have to take the time to put together a presentation nor poster, and then would not have to present said presentation or poster. Yasssss! Another project I am working on was submitted by my co-resident, it was accepted. But when he texted me at the beginning of the week asking if I would present for him, as he had to be out of the country, I ignored it for a day. Maybe if I don't say anything, it'll be like he never asked. No such luck... he just asked again the following day. So despite my best efforts, I again had a presentation during the research day.  Thankfully the study is easy enough to explain and understand, no one asked any questions.

By the time I sat down again, I had pictures sent to me from 4 different attendings. Thanks...I guess.

 

 

I'm still a little confused as to why this is a thing...
But not going to spend the energy to figure out why, so there ya go.

Much Love.

Estoy festejando en la ciudad.

I Love Christmastime in the City.
Especially when it is spent with friends! Amanda, Emily and I visited Jenna and Ethan at their new place in Hoboken Friday night. We then spent Saturday in the city. It had been a few years since I had gotten into the city at Christmastime, so was looking forward to it. It was a day of warm drinks, frozen fingers, many laughs and Christmas trees!

 Bryant Park

 

Midtown Manhattan Library



 

 Rockefeller Center

 L to R: Ethan and Jenna, Me, Amanda, Emily

Much Love. 

 

Estoy mejorando.

I mentioned previously, at the start of this block of Head & Neck, how I am attempting to make use of my time to try take care of myself a little bit. Well, whatever attempt I mustered was obliterated by having three calls in a 7 day period. And as a topper, throw a holiday into the midst of that week sandwiched by calls. I can keep it together at work, that’s not the issue. But by Sunday morning when I got myself home I felt sick until well into Tuesday. Thankfully, my next call has a little more space in between. Let my efforts to “take care of myself” actually maybe have a bit of effect, kind of, possibly.

I’ve been having fun picking my ENT cases while on the rotation. More ear cases. Tubes. Tonsils. Adenoids. Sinuses. Neck dissections and thyroids sprinkled in. Earlier this week we did a combined case with the Neurosurgeons. Drilled into the skull base right where some rather important nerves transverse to get access to a tumor for the Neurosurgeons.  The image was all projected onto a screen in 3-D imaging so everyone in the room could see what the surgeon was doing with her tiny drills. So cool. Granted I’ll never be doing something like that in my future, but super cool to see nonetheless.

I’ve learned that ENTs like snot. There’s always a favorite bodily fluid, even if you don’t admit to it. ENTs see so much snot. Does not change my opinion of it, gross.  I am glad there are surgeons out there willing to dig through it. Even the gelatinous proteinaceous fluid they suck out of ears, borderline gross.

And, not a day goes by when I don’t get asked, “what are you doing here?” It’s usually a scrub tech or nurse that has popped their head into the ENT room for something. They notice me, do a double take, probably second guessing if they walked into the right room, once satisfied that it is in fact me who’s out of place and not themselves, they then ask the afore mentioned question. I’ll be honest, I’m starting to get a bit annoyed having to answer, but have to admit, it’s at least a justified question. I am kind of out of place in an ENT room.

Much Love.

Estoy pintando.

W.O.W event #2 of the year, paint and sip followed by sushi.

 Muse Paintbar, White Plains, NY

Front row L to R: Alex, Sara, Alex

Back row L to R: Michelle, Monica, me

missing in action: Clara and Maria Clara

Making art is stressful. Or attempting to make art. I guess that's why they encourage the "sip" part of paint and sip. As is typical with surgeons, that OCD part of our personality wanted to get the cloud right, and the reflection right, and the color the right shade or tint and the blend smooth. Ha! None of that was even close to achieved though we stood there and tried. If you ask me about my painting, there's a laundry list of things I would change. In the end, that's why I painted Nessie. To relieve myself from the pressure of making a pretty scene. You can look at Nessie, and we can all enjoy a laugh together.


One fact easily recognizable with art, it looks much better from a distance. Up close the individual colors standout and look out of place, and you can make a fuss trying to get one cloud look just right, or trying to blend a specific part of the sky. But taking a step back, that color in combination with the picture as a whole, makes sense. There's a well known reiterated life-lesson to take from that. ;)


1Co 13 9-10,12 For we know in part, and we prophesy in part. But when that which is perfect is come, then that which is in part shall be done away. For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.

Estoy aprendiendo operaciones nuevas

Just barely made it off trauma with my sanity intact. Monday was change for the juniors... for continuity of care the chiefs change on Tuesday. Meaning, I had one more day of trauma to tough it through. As is typical, my Monday morning was spent cleaning up from the weekend. Multiple patients sitting on the floor waiting for a plan. I stopped by and said hello to each one. Promptly followed by a goodbye and take care, but please don’t come back.

 Tuesday I switched to my Head & Neck rotation. Basically I get to follow the ENT residents around and jump in on their neck dissections and thyroids. At least that’s what I am supposed to do. It’s not a real rotation, because we still get pulled back to Gen Surgery to take call and cross-cover when needed. It’s not really fair to the ENT residents, but they put up with us and act like they don’t mind. I plan to take full advantage of the rotation and scrub on everything possible. Tuesday was a bunch of ear cases which I was looking forward to. So Monday, when a chief called me asking me to take his call that night, I couldn’t do it. The idea of more trauma and missing my ear cases, I couldn’t quite stomach it, just so he could do a case he wanted the following day. I frequently stay post call for cases, even 12 hr cases, and figured if he really wanted it, could do the same. I think he’s forgiven me for saying no. But the ear cases were so awesome! One of them a prosthesis was cemented in place within the inner ear that was so tiny with the naked eye it didn’t appear any larger than a twisted ball of wire no bigger than a spec.

I’ve learned so much already, in just the first week. I’m a bit disappointed that a holiday falls in the middle of my rotation. Not disappointed for the holiday, but disappointed as they have nothing scheduled for those days. My days on head & neck are numbered.

I’m also trying to make use of the lack of responsibility I have right now. Maybe lack is not the right word, the vast reduction of responsibility I have right now. We come and operate with the ENT residents... but anything more than that is up to us. I try to stick with them and round with them. One of their patients decannulated herself today! (Took her own trach out) First time I had seen that! Her mom video’d her while she did it too! But, in general my schedule is drastically different than usual.
I am trying to take care of myself a little bit with the relaxed extra time. I am sleeping more. Drinking less coffee. Checking things off my To Do List. Studying more. And in general just trying to enjoy breathing.

Much Love.

Estoy contemplando homicidio.

One more week of trauma, almost there. I didn't think I would be so ready to be done with my block of trauma this time. The work has not been heavy. We've even had two days so far with no traumas at all, and the team is able to keep up with the work flow that we do have.

But if you were to see me in the hallway, in the store or even at church and asked me how it was going. You'd probably receive some sort of complaint surrounding M&M. (Morbidity & Mortality). (An M&M is a confidential meeting at which complications and deaths are presented for review in effort to provide feedback and opportunities for improvement). My life as trauma chief is nothing but M&M. It did not used to be like this. We presented at the monthly multidisciplinary M&M and then when our turn came up at the departmental M&M. Now they want us to present once a week, and they want Ev-Ry-Thing presented. A catheter-associated urinary tract infection is a complication. We have checks in place to prevent them already. There is no educational benefit having me prepare an entire presentation to state that patient xyz had a CAUTI. But they want it now, they want them all. So I oblige and present and then watch as they talk in circles and peacock.

Today was multidisciplinary M&M. My attending had set up a meeting with me and another co-resident last week during which he went patient by patient, pointing at each one telling us which M&Ms he wanted presented. And then again after our weekly M&M I spoke with him verifying new patients that I would include. To which he responded, "definitely, they're mortalities. They have to be presented."

So today, when I stood up and started going through the statistical analysis portion, and that same attending interrupted me to tell me I was doing it wrong.... I was soooooo. Not. amused.  I stared back at him, in my mind, trying to determine if I could successfully verbally rip his head off without anyone else noticing. I know, excessive perhaps, but it lasted a hot second. And I went on with my presentation according to my now brand new rules. My intern had snuck a picture.  Had she ment to take it at that moment of murderous contemplation, I don't think so. 

Zoom in if you dare, but I warn you. It's not a pretty picture at all. Like I said, so Not amused.
As horrified I was to see how I looked in that picture, good reminder that I need to smile more often.

(Disclaimer: I do not now, nor ever want to rip my attending's head off. I do love my attendings, can just get frustrated at their poor management and unrealistic nonbeneficial expectations from time to time.)
Much Love.

Estoy defendiendo mis decisiones

Trauma has been relatively painless thus far. This week proving to be a bit of a challenge logistically speaking. The American College of Surgeons Clinical Congress is in San Francisco this week, so nigh half of our co-residents are in attendance. I had originally anticipated being able to attend myself, until I caught wind of how many others anticipated the same. Put a quick end to any idea I had about going. Someone’s got to hold down the fort back home. So each of us on the team have three calls each in a weeks span to cover. And on top of that our dentist rotator had decided to take this week... of all weeks, to go to Vermont on vacation. But we’re getting by.

As trauma chief, I try to make the best of my position. Use it to exercise how I will want to manage my own patients in the future. I make my decisions, recognizing that my Attending has the right of veto or alteration if he sees fit. Ultimately correcting me where I am wrong and ideally instructing me in what is good and correct in terms of patient management.

Last night, on call, I had a frustrating experience.  Truth be told, the whole day had been frustrating, it just dragged on into the evening and early morning. Frustrating for multiple reasons, one of which was the difficulty we were having coming to a disposition for multiple patients, the longest taking a full 12 hours to put together a complete plan. The one I am going to refer to did not take 12 hours, but it wasn’t much better. Looking at the patients traumatic injuries, her clinical presentation, and family’s wishes for goals of care I finally put together my own plan for what would be the safest dispo.  My attending questioned me about it, I defended it, he agreed and the plan was put in place. A few hours later I had just gotten out of the OR and saw my Attending and my co-resident down the hallway. Quickening my pace I drew nearer in time to hear my Attending mocking my decision concerning that patient. Making my presence known, I immediately called him out on his inconsistency. Thankfully, I have a good working relationship with this Attending, so I did it with a smile and we both laughed at the fact that I had caught him. Plus, I’m not naive. It’s not the first time I’ve been thrown under the bus, and it definitely won’t be the last either. Unfortunately, it’s how certain Attendings work.

The interaction was clarifying for me in a way.

I work hard, as a resident, to learn what is safe and optimal in hopes to be able to make the right decision when it comes to my patients.  I am starting to understand that the vast majority of the time, there is no one optimally correct or right decision. There is only YOUR decision.  Following that you can either then decide to own your decision, or not to own your decision. This will strongly impact what kind of surgeon you are.

I will never stop trying to discern what is correct and safe, and I pray that if there is a right decision, that I can make it. But I also pray that I can have the strength to always at least own my decision, whatever it may be.

Much Love.

Estoy llenada.

Another block is over. I'll be honest, I was glad for the change. Not because of the rotation itself, I love hepatobiliary. And the pancreas...as scary as it is to mess with the pancreas, I love it! But it was just myself and a rotator on the service. She was nice, and enthusiastic. We got along fine. But she somehow missed the fact that a team of two is still a team.... and that got old by the end of four weeks. Frankly, I was rather annoyed and ready to be on a different team.

So now I'm back on trauma. And haven't been in the OR since. I miss operating, but... I'm really glad to be on a team again!
In the middle of rounds today, our OMFS rotator interrupted me to point out I had a piece of pepper stuck in my teeth. Having just met him two days prior I was initially taken aback at his boldness, but on second thought quickly replaced that with happiness that my teammates will watch out for each other. Leave it to the face/dental guy to care about our teeth!

One of my patients presented with a GSW to his abdomen, went to the OR emergently and now is recovering. Being shot from the front, the bullet was still lodged in the muscles in his back. It was actually so posterior that it was tenting a pinpoint area on his back. I took a blade, made a knick and helped it out. Today as we were leaving the room, I heard a family member leaning over to the patient whisper, "those are the guys who took out your bullet?!" A fascination in his tone, that I really wished had not been there. He was young; why do we live in a place were guns and violence is so fascinating and accessible to anyone, let alone our youth.

Interview season is upon us. Our first batch of candidates came through this week. We wined and dined them by inviting them to our journal club the other night. Here's a few of us residents that came out to represent.

Sitting L to R: Ansab, Vasu, Miles, Agon
Standing L to R: Kenji, Faisal, Maria Clara, me, Hanjoo, Ash

Much Love.

Estoy corriendo con el sol.

Another lap around the sun...

Don't think this day would pass without listening to my birthday song!



Here's a few memories from this past year.

11.2018 Spain

 La Sagrada Familia, Barcelona

Monastery at Montserrat

White beach at Xabia

the Alhambra

Granada

 Ronda

 future retirement location...

Sevilla

New Zealand 5.2019

 Exploring in Campervan

 Routeburn Track

 Routeburn Track

 Lake Marian

 Milford Sound

 Campervan life

 Mountainbiking

Bungy jumping

Scotland 9.2019

 Loch Ness

 Castle Dunvegan

 Flodigarry Pods. Local cuisine

 Quirang

 Glenfinnan Viaduct

Glasgow

 Glasgow

 Arthur's Seat, Edinburgh

Edinburgh

Family pictures 2019

Some of my co-residents hung around waiting for me to finish resecting the liver I was working on! Chocolate cake!  And a BALLOON!!

I got to work with one of my favorite Attendings in the OR today. One perk to operating with him is his random OR soundtrack. You never know what you're going to hear, and it's a little bit of everything. Halfway through our left hepatectomy this song played. Made me smile. The time, the place, the situation... it all made me smile.

One Day- Matisyahu

Sometimes I lay under the moon,
And I thank God I'm breathin'.
Then I pray don't take me soon,
'Cause I am here for a reason.

Sometimes in my tears I drown,
But I never let it get me down.
So when negativity surrounds,
I know someday it'll all turn around because -

All my life I been waitin' for,
I been prayin' for, for the people to say;
That we don't want to fight no more.
They'll be no more wars,
And our children will play -

One day! One day! One day!
One day! One day! One day!

It's not about win or lose, 'cause we all lose,
When they feed on the souls of the innocent blood,
Drenched pavement keep on movin',
Though the waters stay ragin'.

And in this life you may lose your way, your way.
It might drive you crazy,
But don't let it phase you, no way, no way!

One day this all will change,
Treat people the same,
Stop with the violence down with the hate.
One day we'll all be free and proud to be,
Under the same sun, singing songs of freedom like.

Much Love.