Yo estoy...: September 2019

Monday, September 30, 2019

Estoy aprendiendo.

I said good-bye to yet another Attending today. Sad as we are to see another teacher move on, we knew he wasn’t happy at Westchester.

He’s not replaceable, but there have been a couple new hires recently. One in particular, apparently comes with the reputation of being able to turn around hurting programs. Having a discussion with another one of my Attendings, he confessed to me that he as well would have long moved on from us had it not been for this particular Attending coming to Westchester. Said he would give it a year to see what happens. I made him promise to at least give it two. The rate of Attending turn over in the past four years... absolutely ridiculous!

As I continue to learn and start to develop my own preferences and opinions on protocols in place, the more I start to notice and appreciate the lack of common sense in what we do in medicine. We act and make decisions, even develop protocols, entirely based on protecting our selves from litigation rather than what is really necessary.
For example, I tried to give some push back to a request from the ED last night. Immediately got a retort that it’s “how it’s always been done.” I didn’t push any further, interpreting the futileness of such an effort against someone unwilling to think independently. So I acted according to “protocol,” feeling incredibly pointless in the process recognizing that what I was doing was completely unnecessary.
Another case last night was transferred to us from a hospital in upstate New York. Patient was actually flown to us and activated as a trauma on arrival. Patient had trauma to his upper chest and then an incidental finding in his distal abdominal aorta. Looking at the case with a little forensic common sense the force and direction of trauma the patient had to have received in order to result in his thoracic injuries leaving essentially a benign abdomen on exam, would have in no way caused the small incidental finding in the distal abdominal aorta. Understanding the first hospital had reacted out of protocol, we couldn’t fault them. Unfortunately, it had given the patient and his family the impression that he was requiring emergent surgery and about to die without it. As you can imagine, they are both confused and borderline irate when we do not react in accordance with that impression. It was an interesting conversation explaining things and calming them down to say the least. But definitely not the worst I’ve been through. They were calling me Heidi by the end of it, for some reason I reminded them of the Swiss children’s story heroine. Like I said, it was an interesting conversation, but I took Heidi as a good sign and a time to exit finally. My point of that case as well, is the lack of common sense leading to much confusion, misunderstandings, and a 50,000 helicopter bill, all for us to pat him on the head and in reassuring tones say “you’re going to be okay?!”

Much Love.

Wednesday, September 25, 2019

Estoy contando pastillas.

Seems summer temps came back for a second visit in New York this year. I notice it as I walk in and out of the hospital every day; whether I need to hug my jacket tighter or not. I’d usually try not to say anything about the weather for fear it would come out sounding like a complaint, but I do appreciate being warm.

My two weeks on Pediatric Surgery went by way too fast. I love playing with the kids. Had some really cute ones this time and saw some pretty fascinating pathology in those two weeks. I appreciate the faster pace of the pediatric surgery service. For example last Friday we blazed through 7 surgeries. Five of those kids admitted just that morning or from the previous night. We operated and then by the end of the day had discharged four of them as well, all while taking care of our already admitted kiddos. If I had a mic… I’d drop it!

Due to my two weeks of vacation, I then had to complete my entire share of calls within the last two weeks of that block. It made for a notable amount of call the past two weeks. I wasn’t about to give up all my cases though so would return post call to operate. It worked out well. Post call I would go home and take a nap; wake up when the PA would call me to say the case was about ready! I’d go in and operate, maybe run the list with the team, make sure everything was smooth. Then go back to my day. I feel like I can breathe a bit easier going into a new block with my calls spread out over the four weeks rather than two.

My last call was an interesting one. Had to change my scrubs not once, but twice, and my black jacket is now in the laundry basket. Needs more of a power wash this time. Wise the person was, whomever decided to make those jackets all black. Unwise the person was, who decided knife fighting a good idea. And for pity sake, if you’re going to ride a motorcycle, wear full protective gear. Not those pathetic half-helmet things, they don’t do any more for you than a baseball cap would, in a word… unwise.

Much Love.

Saturday, September 21, 2019

Estoy mirando al futuro.

The pediatric-age human body has two main jobs 1) Growth and 2) Adaptation. Both of which it can, and does, achieve with speed and efficiency. This, combined with the fact that Pediatric disease is incredibly rarely ever self-inflicted, are defining characteristics of the field. In other words, and to put it bluntly, it is very hard to kill a kid. No matter what life throws at them, they can adapt, heal and recover.

But sometimes, the never happens anyways.

I love Pediatric Surgery. Quite honestly, if I were smart enough, I'd pursue the fellowship before developing myself in Global surgery. There's so many kids in this world that have surgical disease and without help... there's only so far even the pediatric body can adapt.

As hard as it is to light another candle in heaven, it is twice as hard to find a flower among those candles. If I could help limit those flowers, then praise God!

Much Love.

Saturday, September 14, 2019

Scotland.

The Highlands. Sheep dotted fields intermingled with the Heilan coo (Highland cow) here and there. Afternoon tea. Castles. Clans. Fairies. Monsters. Harry Potter. Bagpipes and men in kilts. For any and/or all of the above, one must visit Scotland. I went with one of my co-workers, Monica, and we had an absolute blast!

We wasted no time whatsoever. From the airport in Inverness (the capital of the Highlands) we picked up our rental car and drove to Culloden. You can not read about Scottish history, without hearing about the battle of Culloden, where the Jacobite army was defeated and the uprising lead by Bonnie Prince Charlie was ended.

Battlefield of Culloden

From Culloden we stopped by to see Clava Cairns (standing stones) before heading into the city.

Inverness

High church, Inverness.

View along the river Ness from Inverness castle

View along the river Ness. Inverness Cathedral.

View along the river Ness.

View along the river Ness. Inverness castle

View along the river Ness.

Jacobite boat trip on Loch Ness

Medieval Urquhart castle on Loch Ness

Loch Ness view from Urquhart castle

See rocks and stone walls. Will climb. Some attempts more successful than others.

Loch Ness view from Urquhart castle

Playing in Loch Ness. Nessie did not respond to our whistles and calls... that we were aware of at least!

Loch Ness

Loch Duich

Stopped at Eilean Donan Castle along Loch Duich. It was raining at the time and we didn't actually pay for entrance here. For added bonus, take a look at the castle as it's captured in the following video!

Crossing over the the Isle of Skye we drove through the Cuillin Hills

Cuillin Hills, Isle of Skye

The main road split at Sligachan. We stopped and walked down below the small and unsuspecting bridge of Sligachan to the Enchanted Waters of the stream running down from the mountains.

As legend has it, there was a fierce battle between Scotland's warrior woman, Scathach and Ireland's favorite warrier, Cu Chulainn. As the battle raged, the daughter of Scathach ran down to this stream to cry. The fairies of the river heard her cry and instructed her to dunk her face in the stream. Once she did, she was granted the knowledge of how to stop the battle.

And there you have it, by dipping your face into the stream below Sligachan bridge for a full 7 seconds, and then allow it to dry naturally, you attain eternal beauty!

Loch Harport. Isle of Skye

Loch Harport. Isle of Skye.

Evening stroll after dropping our bags at our hostel for the night

View of the sunset from our hostel for the night. Yes, that's a huge chess board. No, we didn't play a game.

The next morning we were very excited to go and explore the Fairy Pools on the Isle of Skye. Scotland's weather changed our plans for us. We sloshed through the mud as far as we could go.

Determined to see the Fairy Pools!

Having second thoughts...

Tea and cookies it is!

On to Dunvegan castle

Dunvegan Castle

Dunvegan Castle is the home of the Chief of Clan MacLeod. Pictured here in the center is the Fairy Flag of the Clan MacLeod. Many versions as to its origins, my favorite being the following... once upon a time, the Chief MacLeod married a fairy and they had a baby. When the fairy had to return to her people, her only request was that the child never cry. One night the baby's nurse left the nursery to join in the castle celebration that was happening. In her absence the baby began to cry. When the nurse returned, the baby was wrapped in the blanket and the fairy lullaby was playing. Legend has it that when the flag is flown help will be granted.

When the 27th Chief had the flag securely framed as you see in the picture he listened as an expert in the field shared his opinion on the origins going back to Scottish expeditions to the Middle East of the 1060s. To which the Chief politely listened and then responded, "Thank you Mr. Wace, you may believe that, but I know it was given to my ancestor by the fairies."

Dame Flora MacLeod was the 28th Clan Chief. During World War II, if the German's had attacked she had promised to fly the Fairy Flag. They never did, meaning... there is still one remaining flying of the Fairy Flag left to be honored by the Fair Folk.

View from the Woodlands across the round garden towards Dunvegan Castle.

Roadtripping in the Scottish Highlands! We were totally paying attention to the road!

Well hello there. How do you not stop and take their picture, especially when they're posing so perfectly for you.

Flodigarry. Isle of Skye.

We had an app on our phones to alert us of geomagnetic activity! It is not uncommon for aurora to be visible from Scotland and out time on Skye had plenty of geomagnetic activity recorded! We kept our eye out, but clouds for the most part were too thick. You could argue otherwise, but there is definitely color other than black there!

Sunrise from our front porch at the Flodigarry pods.

Morag, our Flodigarry pod for a night's stay on the Isle of Skye