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.

Estoy desilusionada de jugo.

Completed my first chief call! It was fantastic!

It’s been a long time coming, further prolonged by the fact that we have so many chief residents this year, us 4th years are getting gypped of our chance to take chief call, among other things.

So what’s the role of a Chief resident on call? Only one thing, operate!
Of course to help out the whole call team when needed, attend to the level 1 traumas, etc. But so much of the small stuff does not need to reach the chief resident level.
It was actually a little unsettling for me to not know everything that was happening. I instead had to trust my senior to let me know when and where he needed me. I do hope that part gets easier for me.

I had a couple of smaller cases in the morning, but the vast majority of my call was taken up by one patient. To put it mildly she was sick. To be more blunt, she was exsanguinating. Our attempts at temporizing the bleeding, futile. When she looked at me and asked for juice, I knew there was no avoiding the operating room that night. I had to gulp back the desire to push her to the operating room right then and there. Going to my attending, I explained...”she asked me for juice.”
A very random request, almost inappropriate, but I’ve seen it multiple times before. A dying request.

I told her no. No way! Not this time!

Much Love.


“After this, Jesus knowing that all things were now accomplished, that the scripture might be fulfilled, saith, I thirst.  Now there was set a vessel full of vinegar: and they filled a sponge with vinegar, and put it upon hyssop, and put it to his mouth.  When Jesus therefore had received the vinegar, he said, It is finished: and he bowed his head, and gave up the ghost.”  John 19:28-30

Estoy volando con higados.

I am back on transplant service again. Thus far it has been slow, although I do hear of some hints it may be picking up shortly. We have a couple patients high on the list. I'm trying not to be anxious by the non-operative time we've had over the past two weeks. It's allowed me to get some research done, and I've been able to cross-cover for some cases on other services. I was able to go on a procurement this past week, but unfortunately we had to pass the organ off for another lucky patient as it ended up being too small for our own patient.

 Even the small airports can have traffic!

 Beautiful day in New York!

 Hurry up and wait! That's Dr. Nishida, us residents are a fan!

Home again, Home again!

Much Love.