Estoy tratando decidir si o no para comprar helado. (Las preguntas grandes de la vida, no?)

Can I tell you about my week? Please, come and sit by me. Lend an ear for a second. I'll repay in kind.

While rotating at MidHudson they keep us on the resident call schedule down at Westchester. It honestly does not make much sense to do it that way as it means we are now on call every weekend, and unable to follow our patients up at MidHudson, but that's another conversation. My attending called me to come up to MidHudson for a case last Sunday. Not a bad thing, it was a big abdominal wall reconstruction case. It was a pretty impressive feat for my attending to undertake and required a bit of ingenuity and creativeness. At one point we had come to a pretty good closure and everyone was happy. But then someone suggested we could do better, and so we did more. I'll spare details, but you know that phrase that "better is the enemy of good?" That was the feeling I ultimately had at the end of the case. Time will now tell how it ends. Everyone is watching and waiting, without admitting the obvious that we are all secretly scared it's all going to fall apart. I pray to be pleasantly surprised.

Monday I had asked James if we could carpool and thank goodness because I woke up that morning quite sick. Felt better after some reverse peristalsis and thought I could handle the day. I got some zofran from the anesthesiologist and was able to successfully make it through my first case, but as the zofran wore off so did my reserve. Laid down my instruments in the second case with just enough time to make it out of the OR and yet again puke my guts out. Soooo embarrassing :( I tried scrubbing back in one more time and had to finally give it up for the day. I let James finish the rest of our cases while I sat in the back of the OR with a blanket wrapped as tight as I could to ward off the onsetting chills.

The following day I was able to get up and move around relatively trustworthy of myself again. We had mandatory mock orals down at Westchester that morning. So I left James to drive up to MidHudson by himself. To describe how I faired on the mock orals, the phrase 'blundering idiot' sounds about right. Even my attendings were appalled and openly disappointed in my performance. One of the rooms, they even asked me what was wrong. The fact that I was sick the day before and now weak, dehydrated and still food shy seemed like an acceptable excuse, definitely one they couldn't argue with. So I offered that up as "what was wrong." But inside, I know what a weakness I have in answering oral questions on the spot. I was blessed with that talent which enables one's mind to go absolutely blank when asked a point blank question. And on the rare occasion, my mind doesn't blank I then second guess myself until I scare myself out of answering anyways. Really, it's fantastic!

After emerging from mock orals I opened my books to study, and sent a message off to check in the James. The cases up at MidHudson were supposed to be about done for the day, but to my surprise there were still three cases pending. I left my books, grabbed my keys and made it up in time for the last two cases. Totally worth it.

The rest of the week was relatively benign. I was disappointed in not getting to be as involved in cases as I would have preferred. Had to fight back some nasty jealousy, which wasn't fun. I am starting to feel more comfortable on the robot though, so that is fun!

And then I was scheduled to be on call this past Saturday. I came in prepared for the worst. We all did. Kept waiting for the St. Patrick's day-induced onslaught of stupidity that took too much too far, but it never came. 06:05 am Sunday morning we all looked at each other after not having a single trauma the whole night, asking "what just happened?" And we had no answer, but felt content to leave it at that. On the other hand, I stiller left the hospital this morning with a new sourness settled deep in my stomach. Replaying decisions I had made over the course of the night, only able to come to the conclusion that shouldha', couldha', wouldha' are some of the best teachers.

So I started the week with a sour stomach and here I am still sour, and I'd like to finally be able to release it and move on.  Easier said than done, but thank you for lending an ear anyways. :)

 Here's a painting of the hospital I appreciated from one of the murals at MidHudson. Hudson River Valley really is a beautiful area!

And I finally filled up my record book so wanted to document the change in size difference of my old record now fat and filled with stickers from all my cases compared to the new record slim and trim waiting to likewise be filled with stickers and cases. 

Much Love.

Estoy practicando en la comunidad.

Back at the end of last December, within a period of 48hrs, our monthly scheduled rotations changed three times. Between you and me, it was all still pending changes needing implementing prior to our program’s site visit... which then happened just two weeks later. But better late than never I guess. One of these new rotations is at a community hospital up in Poughkeepsie, NY. A good hour drive away from Westchester. I am scheduled there for the month of March.

It’s been an interesting rotation thus far. There are two residents scheduled for MidHudson Hospital up in Poughkeepsie each month, however, that’s as far as the clarification goes. The hospital was operating well without residents, so then to suddenly and at a moments notice throw residents into the mix, no one is quite sure what to do with us. What we are or are not expected to do. Responsibilities, etc. However, if you leave that up to us residents, it’s pretty simple... let us operate. So for the most part that’s what James and I have busied ourselves with this month. Every morning we head to the OR and only leave it when the cases are done. It’s a community hospital so there are not cases 24/7 like at the large academic centers like Westchester.  There’s even some days were there are no general surgery cases, but the fantastic part about that is we are the only residents there so we can have our pick of Urology cases or Orthopedic cases or Gynecology cases if we desired. In other words, the OR is our oyster. I know some of my colleagues will prefer to occupy themselves elsewhere on those days, but last week when it happened I choose to take out a few kidneys! As I mentioned, it was fantastic!

All of the Attendings that we have had the opportunity to work with have been excellent. As we previously had with St. Vincent’s hospital in Bridgeport, the community hospital is a different pace and practice of medicine and surgery than at the academic center. I argue that it is incredibly important to a resident’s education to see and experience the different settings in which we could potentially work one day.  The pace at a community hospital is much more relaxed and yet believe it or not, it’s faster as well. The Attendings also play a large part of that education.The thing that I love most is that in the community setting is where you will find the “General Surgeon” in the old true sense of the title. The surgeon who trained to operate on the whole body, and still could if you asked him to. The surgeon who asks what the name of every obscure vessel is. The surgeon who will yell at you if he sees one drop of blood, you’d better leave the OR, get in your car and never come back to Poughkeepsie! And he’s serious too!

Got it! Not a drop of blood! Hand me the knife! ;)

Much Love.

Estoy mirando el camino.

I had a past med student once send me a message asking a question. She led into her question by first asking my whereabouts, was I perhaps on a really fancy Parisian vacation? In which case she then offered me a bonjour from across the pond. But then getting back to her real reason for texting she asked, “what do you do when you face a setback?”

Setback? Closed doors? Rejections? I’m not sure to what exactly she was referring, and I didn’t ask.
I first thanked her for the quick mental Parisian vacation and then empathized with how she must be feeling.
How I dealt with setback:
1) I remind myself of WHY I am here.
2) I then go back to the basics. I explained to her that I go to the simplest thing that I have control of. When I can’t control my situation, what others think of me, or say to me. When I can’t go where I want or do what I want. Whatever the setback may be, I study. I continue to better myself in the one thing that I know I do have control of. I want to be a surgeon. A good and safe surgeon. When setbacks make it seem more difficult, the basics of a good and safe physician or surgeon is to never stop learning. And so I study. I study until the world rights itself again and the way past the setback becomes clear and I am able to take the next step forward.

That’s what I told her back then. And I think I was getting too comfortable like that, at least, that is what I have concluded. Now I’m getting ahead of myself, actually starting with the end of the story. If you’re the type of person who likes to read the last page of a book first, there ya go. I was too comfortable. El Fin!

God decided it was time for me to grow again.  Two things happened this past month that God used to shake me up.
1) I started researching ‘the next step’... the part that happens after residency. And I found a whole lot of nothing. God taught me long ago He was only to show me one step at a time, and I on the other hand had only to trust. So when I looked for my next step... and it wasn’t there. It shouldn’t have come as a surprise. But it did.  In retrospect, having five years of my life semi-defined has provided me with an element of comfortability that I have slipped into.  And using those same glasses looking forward, I ask what would be comfortable and easy? Apply for a fellowship, complete said fellowship, and then start working. But that is not WHY I am here.
2) My studying failed me. I’ve failed exams before, that’s no big deal, and usually explainable. This was more I failed myself. I couldn’t even bring myself back to the basics to get my feet underneath me again, because it was the basics that had failed. How can I be a good and safe surgeon, if I am not able to learn? What are the basics now?

The human being is really a predictable entity, myself included. We all struggle with control, fear, love, justice and purpose. Granted to varying tunes and different levels from individual to individual. But the human story is relatable. And even if you asked an atheist, to look at the stars from the top of a mountain, they’d look and say WOW!
 I’m almost ashamed that I was shaken, had I not been relying on myself and my own abilities, God would have had no reason to pull me out of myself and back to himself. What can I say... I’m not perfect. In fact, I am nothing. Back to the basics 101.

Much Love.