Estoy abrochando el cinturón de seguridad.

Another year of residency under the belt. It this point I’ve been walking the hallways of Westchester Medical Center for time longer than most other employees within its walls. Save a handful of the dedicated nurses, longer than most nurses, techs, aides, cafeteria workers, even half of the Attendings now as well.

PGY 4 starts tomorrow. A brand new batch of interns start tomorrow as well. It going to be a rough year. Can tell by the drama that has been in these past three weeks leading up to it. Three weeks, time enough for me to give up and buckle my seatbelt. It’s going to be a bumpy ride. There’s been numerous scheduling changes, new requirements, new expectations, it’s all on a whim without discussion and now people are already upset and disgruntled and the year hasn’t even started. So like I said, buckling up. Going to be a bumpy ride.

Saying an extra prayer for us all!

Much Love.

Estoy esperando el vuelo

Airports really are fantastic places. So much food for the imagination as people parade past in unending display. God really did take the time to create each one, and you can tell by the way they hold their head and subconsciously announce their presence to the world. Who opted for the comfortable style, who for the fashionable? Who is traveling with the smallest baby, who the largest instrument? Hmmmmm, interesting tattoo. I myself, went for a more eclectic look this time. Not outrageous, just on the fringe of weird. Thought it would be fun to confuse people a bit. Silly me, I had forgotten just exactly the situation I was headed into. As a general rule, its an inverse relationship, the more populous a public place, the less any individual is noticed. 

Being in the ICU this month has granted me a rather unusual schedule. So while I appreciate the typical end-of-the-year drama the rest of my colleagues are struggling with back at the Chester, I am thankful to appreciate it remotely via What’s app texting strings. I took advantage of my odd scheduling and flew to Illinois for a quick 48hr visit. Have to periodically stop by and play with my nephews. The baby is growing up with or without me, might as well make it with when possible.

I had limited the visit to 48hrs so I could be back in NY in time for our residency graduation. After delays and then sitting on our plane for over an hour without moving I noticed workers start to unload all of our luggage. I sadly faced the realization that I was not going to make the graduation. I started residency 5 years ago with our graduating chiefs: Matt Bronstein, Kristina Dzeba and Niu Zhang. For the past five years they have been in that group of people with whom the vast majority of my time is spent. I didn't get to hug them goodbye and farewell. I probably had placed too much priority on being there, and hence why God saw fit to delay my travels and instead entertain me with his creation throughout terminal 3 of O'Hare airport.

That guy just tried to pick up two Aussie chicks. Their response polite, but not interested. Quite amusing. 

On suggestion and request of Mom, Carrie arranged for a professional family photo session during those 48hrs. It went well! The weather was nice. The boys smiled. Will be interested to see what our photographer was able to capture. I, of course, grabbed my nephews for a few extra shots.
 

 Peter Bear, Little Lincoln and Miles Austin

 Love me a Miles Austin squeeze between Mom and myself

Look at this cutie! Not such a baby anymore!

 Love you Peter Bear!

Story time!

Much Love!

Estoy preparando familias.

There is a side of critical care not often spoken about. It should be, and a good comprehensive ICU will include these services, as well as be adept at approaching the subject and involving family when appropriate.

Palliative.

My natural instinct is to recoil and dismiss any palliative measures as they kiss the boo-boo without solving the problem. But sometimes, making the hurt go away, is not only the merciful option, but what the patient actually wants. I'm not the only one with tendency to shy away from palliative medicine. Sometimes a son will hang onto a father; a mother onto a daughter prolonging the inevitable in a slow painful process.

Not easy conversations. Not easy decisions. No one can deny that.

A human life, full of memories. Secrets shared. Tears cried. Smiles laughed. It's significant.

I was in Boston the other day. Those cobblestones, those brick walls. What stories they have seen unfold, one can only imagine. We took many pictures as we walked, mainly of those walls, and windows and doorways. The history etched into the very architectural fabric of them all. It makes it beautiful.

 Old State House

 Old State House

 Old North Church

 Commandant's Residence

 Ride your bike to the Charles River for a nap... why not?

Balance between returning home and moving on home. 

Much Love.

Estoy soplando burbujas.

Had a good first week back. Nothing special happened, no fantastic cases to report. No, I wasn’t even in the operating room. I’m in the ICU for another month so was expecting more of the same from last month. Prior to going to New Zealand, I was very unimpressed with my rotation. Was not learning anything new and my duties required no thought process to complete. To put it mildly, I was struggling... a bit.  My last day before vacation I walked into the hospital to the sound of “76 Trombones”. Granted it was just in my head, but I’m sure my knees kicked an inch higher than usual anyways. So, naturally, I was expecting more of the same upon return. However, this past week staffing was short in the units. There was one Attending and one Fellow to cover both Trauma ICU and Surgical ICU. They would come touch base with me first thing in the mornings and then leave me to it! Understanding that I would successfully perform all plans and trust that I would communicate any concerns. And it ended up being a very busy week with no room in the inn... The trauma ICU gets capped. Once the beds are filled up, that’s it. Not the case with the SICU. When my beds were filled, my patients just overflowed to empty beds in other ICUs or post op patient’s stuck in the post anesthesia care unit. It just means I end up traveling all over the hospital to round and check my patients. And then we all get caught in a game of musical beds. Play it long enough and by the end of the day you wonder if you actually took care of any patient or was all your time just spent pushing them around. So in short, to be allowed the freedom to handle the unit and at the end of the day sign out with clear plans (on most patients) and everyone still breathing I feel thankful my team was comfortable enough to leave me alone. Don’t get me wrong, I didn’t go rogue. Any big change I enacted in a patients care I made sure to shoot a text to the fellow with what I was doing. Both so he wouldn’t be surprised when rounding back through the SICU again, and also to give him the opportunity to veto me, which he never did. And at the end of the week, my Attending actually turned to me and thanked me.

But now, it’s a new week, and a new team. After being away for the weekend, which is always welcome, but plans tend to get lost with all the change in call shifts over the weekend. It was frustrating to not be given any basic plans when I arrived in the morning. And then the new Attending didn’t round until late afternoon. It took all day to pull together plans on some of my patients. Left time for a moderate amount of thumb-twiddling. And I’m reminded again of why I’d rather just go to the operating room. At least I have my own plans now for going into tomorrow.

Much Love.

New Zealand

My friends and I just spent the past two weeks travelling across New Zealand in a campervan, dubbed JAC. The hours and kilometers took us past countless mountains, forrests, fields and pastures, alongside the oceans and many lakes, through rainstorms, sunbeams and dark sky reserves. I journaled my observations and understandings of the people and culture of New Zealand as we journeyed, and our adventure developed. If I could use one word to summarize it all, it would be Magic. It was so easy to see and understand why this land was used for the setting of a fantasy world, Middle Earth.

"Still round the corner there may wait 

A new road or a secret gate;

And though I oft have passed them by, 

A day will come at last when I

Shall take the hidden paths that run

West of the Moon,

East of the Sun."

J.R.R. Tolkien

 Christchurch, NZ. Cathedral Square. The Chalice remains erect next to the Cathedral destroyed by the earthquakes of 2011.
 

 Christchurch, NZ. Destruction of the cathedral by earthquakes in 2011

 Christchurch, NZ. Bridge of Remembrance

 Christchurch, NZ. Avon River

 Christchurch, NZ. Botanic Gardens

 Christchurch, NZ. Botanic Gardens. Talk about a great climbing tree!

 Christchurch, NZ. Botanic Gardens. Fall colors on fleek.

 #vanlife under way!

When the sunbeams call, you pull over and chase them! Jenna & I

 Jenna & I, chasing sunbeams.

 Lake Tekapo.

 Lake Tekapo

#thatwanakatree

 #thatwanakatree

 Wanaka, NZ.

 #thatwanakatree

 Wanaka, NZ.

 You can't camp without having s'mores!

 AJ Hackett Nevis Bungy. Queenstown, NZ.

 All smiles and ready to go!  Jenna, Amanda, me

 Nevis Bungy 134m.

 Lake Wakatipu

 Lake Wakatipu

 NZ countryside

 NZ countryside

 Lake Te Anau

 Routeburn Track

 Routeburn Track. Amanda & Jenna

  Routeburn Track

 Routeburn Track: "Look it's a yellow diamond!" A.V.

 Earland Falls. Routeburn Track

 Lake Mackenzie. Routeburn Track. Jenna, Me, Amanada

 on Routeburn Track. Me, Jenna Amanda

 Sunrise on the mountain. Routeburn Track.

  Sunrise on the mountain. Routeburn Track.

  Sunrise on the mountain. Routeburn Track.

 Routeburn Track

 Earland Falls. Routeburn Track

 Lake Howden. Routeburn Track

 Routeburn Track

 Routeburn Track

 Routeburn Track

 Lake Marian

 Lake Marian. Me, Jenna, Amanda

Hollyford River

sunset on the mountains

 Milford Sound - Fiordland, NZ

  Milford Sound - Fiordland, NZ

  Milford Sound - Fiordland, NZ

  Milford Sound - Fiordland, NZ

 Milford Sound - Fiordland, NZ

 

  Milford Sound - Fiordland, NZ

 

Opening of Milford Fiord out to the Tasman Sea

  

 Milford Sound - Fiordland, NZ

 

Stirling Falls,  Milford Sound - Fiordland, NZ

 

Stirling Falls,  Milford Sound - Fiordland, NZ

 

The Chasm - Fiordland, NZ

 International Dark Sky Reserve; one of only 10 in the world. obviously my simple camera could not do justice. But what our eyes beheld looking up that night... it deserved a spot holder here out of pure speechless awe.

 Greeted by the sunrise when freedom camping.

 Kaikoura, NZ.

 Kaikoura, NZ.

 Kaikoura, NZ.

 Kaikoura, NZ.

 Kaikoura, NZ.

 Seal colonys at Kaikoura, NZ.

 That sun though. It calls you to come play. Kaikoura, NZ.

 Kaikoura, NZ.

Picton, NZ. Crossing to the North Island.

 Picton, NZ. Crossing to the North Island.

 Crossing to the North Island.

Crossing to the North Island. Over the spread of the two weeks, we put away almost that entire Nescafe!

 Tongariro Alpine Crossing. Looks a little cloudy...

 Tongariro Alpine Crossing. But ahead of us...

 Tongariro Alpine Crossing.

 Tongariro Alpine Crossing.

 Tongariro Alpine Crossing.

 Tongariro Alpine Crossing. The Emerald Lakes.

 Tongariro Alpine Crossing. #wemadeitoutalive

 JAC transitioned into a campervan/place to hang all our wet clothes! me, Jenna, Amanada

 relaxing in the natural thermal hot pools of Rotorua, NZ.

 finding a cafe to check in on social media! Rotorua, NZ. Jenna & Amanda

 

Cornwall Park, One Tree Hill - Auckland, NZ

 One Tree Hill - Auckland, NZ

 View towards Auckland city centre, One Tree Hill

One Tree Hill - Auckland, NZ. Amanda, me, Jenna

 University Clock Tower - Auckland, NZ

 Albert Park - Auckland, NZ.

 Aotea Square & Auckland Town Hall - Auckland, NZ.

 New Zealand makes good use of boxcars!

I basically had to climb a fence to get this pic! :) Auckland, NZ

 Best Ugly Bagels - Auckland, NZ

Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ. Amanda & I

 Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ. Me, Jenna, Amanada

 Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ.

 Christchurch, NZ.

Christchurch, NZ.

Like I said... Magic.

Much Love.

“I think I’m quite ready for another adventure.” J.R.R. Tolkien