Estoy una comunicadora excelente.

Block one of the year is already over. We had a small team on Vascular, and we managed, but I think we all felt the strain from carrying extra work. I started out the year with one of the busiest services, but I guess prefer that than finishing with the busiest.

I've been the senior most resident on my service for the past year, and in that position, the acting chief resident of the service. So I was therefore not expecting this year to be so different. But there is an expectation, a responsibility, and in some cases a stereotype that comes along with the position of chief resident. And trying to live up to that expectation, fulfill that responsibility and if possible break the stereotype that if I'm honest, really has me struggling at times. If I were to give myself a grade on my "chiefing" thus far, it'd be a nice fat F for failure. I've got so much work to do the next 12 blocks.

One of my biggest failures is communication. I'm not a fan of unnecessary and/or futile communication, it's inefficient and waste of time, in my opinion. But I remember chief residents getting so angry with me as an intern when I would unintentionally leave them out of the loop on an event. It was always unintentional, but I would simply be taking care of a situation, perhaps communicating directly with the attending, or someone else involved, and forget to let any third, or forth or fifth parties know what was transpiring. I guess all their yelling really didn't impact me, because I still have found myself in similar situations, only difference is now its the Attendings getting angry with me rather than a chief resident. It's easier with our teams now because we have group chats that all updates and issues get sent to, so every resident on the service remains updated at all times. Not such a acceptable idea with Attendings, so if something happens I have to text/call/message not one but multiple, all who may be interested. And when I'm in a post call exhaustion, trying to keep it together to get plans for my team to carry out for the day, all while not missing a fever, or a drop in hematocrit, or forgetting a pulse exam, or antibiotic, or anticoagulation regimen.... superfluous communication is the last thing on my priority list. Maybe by confessing, I'm hoping that I'll be able to remember next time, and do better at my communication.

I also realized towards the end of this block that my poor communication is negatively affecting my interns as well. On Vascular, as I mentioned, it is super busy. In order to give my team as much time to get ready in the morning I request to meet with them at 06:30am, but in meeting at such a time it means we really have to fly through our rounds. It is not uncommon to see a vascular team member running down the hall or up/down the stairwell to catch up with the team as he or she was left at the last patient to finish the dressing change. Once again, I prefer to cut out superfluous communication in order to speed things up, and therefore let the patient know the plan for the day and then check over my shoulder to make sure the team understood the plan as well as we take a quick sprint to our next patient. I don't stop to make sure our intern understands what went into the decision making part of that plan. I realized I wasn't even asking my intern to analyze our patient's vital signs. I was doing it myself in order to speed things up on rounds. I caught what I was doing and tried to remedy it towards the end of the block, but was probably too little too late.

Going to be making a few changes approaching the upcoming block, starting tomorrow bright and early. If I can make small improvements here and there, perhaps I can pull my F up to a D... D- at least?!

Much Love and prayer!

Estoy sola.

We asked for busy. Signed up for it in a way. I'm starting to realize I may not be taking care to get enough sleep to maintain our current kind of busy. I usually rely on caffeine, but its been so busy that I don't have time to get coffee throughout the day, so have to keep going on adrenaline and take care not to ever sit down. I'd not be able to get up again if I did. May have to do some rearranging of priorities... easier said than done.

Medical students were allowed back in the hospital. Hadn't realized it until I saw the short white coats wandering the hallways, but it had been months since last seen. We don't let them go to see any COVID patients and they aren't allowed to scrub on any COVID + cases, so keeping their exposure limited.

We haven't had our increase of cases in Westchester yet. Still pending. For now COVID has become more of a check-box. Any admission, were they swabbed? Any cases, what's their result? And on vascular we have many chronic patients, we list their COVID status on our list, making sure to repeat the swab weekly so as to always have an updated result in case they need an emergent procedure at any time.

The other day I had come in to round with my team and do a quick case. Our patient, COVID +, ended up becoming acutely unstable middle of the procedure, at which time we immediately aborted, and wrapped things up to go to the ICU. It was almost 90 minutes later when we were finally allowed to leave to operating room. I had spoken to the ICU myself, and we were set to go to PACU. I don't need to go through the details, but in summary, due to the patient being COVID positive, everyone wanted to make sure appropriate precautions were in place, dragging their feet, and then changing the plans on us multiple times. I grew rather frustrated with the system, sitting for 90 minutes with a critical patient. What was supposed to be a short case, turned out to be more a waste of time, unfortunately, which didn't improve my frustration in anyway.

But if that is our current stresses dealing with COVID, it pales with what many states are dealing with.  Have you checked the most recent curve? It's available and frequently updated.

It's unreal what is happening in our nation. This virus continues to wipe us out, irrespective of our age, race, gender, etc. People are dying, and many more are going to die. In a way we are acting like school-age children. I remember being still small and my entire universe revolved around me, my needs, my wants, my thoughts, wishes and questions. I had gotten frustrated waiting 90 minutes with my patient. How quickly I forgot what it was like to have our ICUs overflowing, and the hospital buckling under the burden of COVID. Reality in Texas, Arizona, Florida right now... and as those numbers continue to sky-rocket many more. Perhaps even here in New York again.

May we continue to pray for our fellow humans. Those sick, those caring for the sick and for those trying to protect one another.

Much love and prayers.