Estoy escapando.

 Stayed post-call this morning to do a quick case with one of my favorite attendings. Patient had a gigantic cyst in the liver. I popped it, sucked out all the fluid, and the liver deflated like a balloon!  I then fenestrated the roof of the cyst and took care to make sure it never comes back again! Closing the port sites at the end of the case the scrub tech asked me if I wanted any glue, to which I responded "Por Favor!" Albeit, I admit, a bit more overly exuberant than necessary. But thinking that I had said "Praise the Lord!" The nurse in the back of the room joined in with a hearty, "Amen!" And we all laughed!

Managed to get W.O.W. together again. Expanded the event to include some of our fellows and med students interested in surgery. I reserved escape rooms. Had enough people that we had to split up into two different rooms. Both groups managed to escape in time!

Our task was actually to break into a police station and get the safe code off of the chief's computer for the bank safe! Consider the bank robbed! jk we gave the money back again afterwards ;) R to L: Clara (pgy4), Alex(recent grad, waiting to start fellowship in Boston), Aparna (med student), Christine (MIS fellow), me, Monica (MIS fellow)

The second room had to do with aliens, not sure of the story, but they escaped with 58seconds left! (Mary, Michelle (critical care fellow), Kira (pgy1), Thanh (pgy1), Sara (pgy2), Alex (pgy2)

L to R: Alex, Sara, Alex, Clara, Mary, Michelle, Me, Thanh, Monica, Christine, Kira, Aparna

Such a lovely bunch!

Much love and prayers!

Estoy enterrada.

 I was supposed to have time to study this week. Or even before getting to study, I was supposed to have time to catch up on paperwork, applications and presentations all with due dates looming over me. But that's just the thing with transplant, you can't predict when organs will become available. You can't really make plans, or you'll end up like me. I had planned to get my mountains of pending work done, and I am now a week later... still with none of it done. (Well, I did manage to squeeze one presentation in and off the list). 

I mentioned a difficult transplant on my first day on the service. By the time I was home post call from that liver, donor OR time for the next was already set. I went in early for the transplant, another difficult case taking all day. By the time we finished the donor OR for the next liver was set and the kidneys were starting to line up as well. The kidneys went all night long that day. Thankfully my co-chief who was on call stepped in for one of the kidneys so I could run home and take a nap. The following day liver and kidney were going simultaneously, I took the last kidney as it was for the same patient that I had just transplanted his liver the day before, and my rotator covered the liver transplant. I then waited for my attending to finish the liver so we could take our first liver transplant for a planned trip back to the OR. The same the next day as well. By that fourth day... I was seeing my attending start to crack. SEIGO is a machine. One of the other liver attendings, knows when he's reached his limit and calls is quits. Plus he has a huge elective practice that he has to spend time to keep up. He only lasted two livers long. Our kidney attendings, also know when to call it quits. Then there is one liver attending who is the newest to the practice and follows SEIGO's lead. He tried to keep up, but I noticed him start to nod off and have to take breaks. But SEIGO is a machine, he just keeps going, seemingly without sleep. I thought he was amazing!  But then, as I said, he started to crack. On the fourth day, during a long case with me, it actually scared me at first. He would spontaneously and suddenly look at me and scream, followed by a laugh. His hands were shaking and he frequently grunted. Then he started to repeat himself, asking questions that he had just asked two minutes before. But by the end of the case, I had slowly deciphered this new side of SEIGO. First, I finally recognized that he wasn't screaming, but it was actually his attempt at singing. Music is one of his escapes, one of his coping mechanisms. And while he's working, he frequently has a song going through his mind that he must suddenly and spontaneously let out. This song in his head does not always, in fact frequently does not actually match with the song currently playing on his play list. The more tired he is, the more he sings. Second the shaking and grunting, comes from plain old wear and tear on the human body. I realized, he is not machine, but merely man. Standing for hours, the physical toll on his body from bending over and holding the liver to work, he was physically in pain. Never complaining about it, but with every grunt, I could feel his pain. As for the repeated questions, at one point I was finally able to convince him to break scrub and grab a coffee quick. He could think a little bit clearer after that once again. I still think he's amazing, but not as a machine now, just as himself. 

I now have one day to attempt to get all of the work done that was supposed to happen this past week. But first sleep. I just hope I wake up again before Monday starts in order to do it!

Much Love and prayers!

Estoy parte de un servicio nuevo.

 Transitioned to a new service this Monday. For the next three blocks I'll be chief resident on the Transplant/Hepatobiliary Surgery service. Started out with a bang! Not only was I on call, but one of my patient's got a liver and the transplant went all night long.

It was a tough night for everyone involved. Our patient was incredibly sick to start with, my Attendings and the anesthesiologists had to fight and fight hard for long hours. While this was happening, level 1 traumas kept coming in. Working with my senior on call, at one point we had to pull our intern from the floor to cover the transplant as I needed to help with the level ones and our junior was already covering other cases that were happening. This left the floor uncovered, but when fires are burning, you work collectively on the biggest flames and then spread out again. I think my senior aged 5 years that night. Active resuscitation on multiple patients simultaneously, intubating multiple patients, playing musical beds in the ICU... for all those patients being intubated and resuscitated. So many decisions to make and make them fast. Our Attending AWOL throughout it all. We kept things under control, kept everyone alive, operated on those that needed it, and when all was semi-stable again I would head back to the transplant to free up our intern, and then our junior to once again tend to the floor and help with the fires happening outside of the OR. My senior would then come into the OR to run things by me... at that point he didn't really need my help, more my approval of his decisions and reassurance. 

It was also a long night for everyone. I actually fell asleep during the transplant. Was close to 5am at that point. I caught myself, and used peripheral vision to quick check if anyone had noticed, no one had. If it wasn't for SEIGO yelling at me every 30 seconds, "SUCTION! Christy SUCTION! look! look! like this, USE TWO SUCTION!" I'm sure it would have happened more than once! But when I finally rolled my patient into the ICU, the morning was well underway, the various surgical teams already running through the halls to check on their patients prior to heading to the OR. I ran into my senior one last time after he escaped from morning report, and I could relate to the look of absolute defeat in his eyes. I hated myself for not being able to help him more, and did my best to reassure him that he did a good job, and now needed to let go of the rest.

Welcome to Transplant indeed! We have another one tonight, so should probably get some rest quick!

It was actually a little bittersweet to leave Vascular behind. Crazy busy three blocks, but I enjoyed it. I was incredibly blessed to have fantastic teams for each block. You can like what you do, but when you enjoy your team and can trust them, it makes such a huge difference. 

 Block 1: Moe (pgy3), Nicole (pgy1) They did fantastic for being a small team for the first block of the year! And when I texted them to ask for a picture they both showed up and smiled! I hope that means their PTSD isn't that bad!  jk...i hope ;) 

Block 2 I don't have a picture of because my intern was then on night float, so need to get a picture now that she's back on a regular schedule again.

Block 3: Kamil (pgy1), Aryeh (OMFS rotator), Kenji (pgy3)  They also did a fantastic job. They kept our whole team laughing as well. Made for a fun time taking care of our patients with these guys.

Much love and prayers!

Estoy trepando los árboles.

 As we hit halfway through September the general expression I am starting to hear is something along the lines of a desire to no longer be in the year 2020 at all. I can understand. There's been many a year I've been thankful to finally see behind me, never wishing to see the likes of again. But learning, growing and surviving through those years shape us as people and individuals. Our loves, losses, passions, regrets. They serve a purpose in our journey, and wishing to be out of that journey... we run the risk of missing out on those life-altering moments that happen upon us perhaps in the most unexpected time, place and manner. 

I have frequently questioned God on his timing. He patiently permits me to do so, knowing that with a little reassurance I'll calm down again and move on. His will, not mine. For example, I'll admit, I've asked why He's kept me in New York for so much longer than was originally expected. Why here, when I was willing and able to go anywhere? But he choose New York to bless my life, the reason for which He will reveal in His own time. In the meantime, I am thankful for those blessings, and the impact each and everyone has had on my life.

Last weekend, I left my Vascular service in the capable hands of my team, and went exploring in my backyard. Jenna Hartter, Emily Walder and Amanda Virkler joined me in New York Friday evening. Friends that I haven't seen in 6+months. Friends with whom multiple trips and plans were cancelled this year due to COVID. 

Me, Jenna, Amanda and Emily. Saturday morning, Amanda sadly had to leave us for family. But Jenna, Emily and I headed North to get lost in the Catskills. 

Peekamoose

 

Peekamoose

 

Table Mountain

 

Emily captured a handful of candid shots.

A couple of them were real winners!

 

 

 

Some pictures don't need an explanation.They make me smile looking at them and remembering our time in the Catskills.

Camping in the middle of the forrest Saturday night. All of us a combination of sweat mixed with dirt and then frosted with campfire smoke. We shared our campsite with the local deer and chipmunks who were gracious enough to allow us passage through and rest.

So many blessings in 2020. Small, disguised as insignificant, but created specially for us.

Much love and prayer.

Estoy sin palabras.

 I sat trying to dictate what I had just seen. What I had just done. And found myself at a loss for words. There was no official medical term for what I was trying to describe, so was struggling to make my explanation sound official. 

I had been on call and making my way through the list of surgeries that had to get done for the day. This particular case was booked as an Incision and Drainage of a right arm abscess. The patient himself.... not the brightest of fellows as despite strict instruction to not eat anything, had somehow gotten ahold of food. Which moved his case to the end of the line-up and brought us up to about 2am. He had a history of IV drug abuse, with concern for needle being lost in his arm, leading to infection, and bring him to our operating room. I've performed I&D's for similar situations multiple times in the past so honestly, was not quite expecting what I found. The patient had already undergone 2 I&D's on his arm at another hospital prior to coming to us. But when I took down his bandages, I found pus pouring out of his open incisions from those past I&D's. I always feel silly prepping something that is so grossly infected, but I went through the actions nonetheless and dumped on the betadine, skipping the washing part and going straight to the painting part. On exploration of the wounds, the patient's tissues literally would disintegrate between my fingers. I'd probe along the fascial planes and feel the tissues melt allowing more and more pus to escape. I keep going, opening the wounds even wider, looking for any sign of healthy tissue. I could grab chunks of muscle and it would break off in my hand, dead and disintegrating from such horrid infection. Sticking to the basics, which when dealing with such necrotizing soft tissue infection, is wide and aggressive debridement, I kept going until I stopped finding new pockets of pus and I hit tissues that pushed back. I left drains through multiple of the tunnels I had created to prevent any pockets from reforming and blasted the whole arm with pulse lavage, and lots of it. And as I packed the wounds now gaping and bleeding, I kept having to ask for another roll of packing, the defect swallowing up roll after roll.  

I am forever amazed at what our bodies are capable of bearing. What damage we are capable of bringing on ourselves. And I wonder just what pestilences I shall yet see before it ceases to amaze me. I am both thankful and fear I shall never cease to be amazed. 

Much Love and Prayers.