Estoy practicando el coraje.

 I started listening to Christmas music a week ago. Granted my Mom had tried to get me to listen back in October, I'm not as bold as that. I confessed at work one day prior to Thanksgiving. My team, of course, attempted to argue the inappropriateness of my decision. To which I responded, "It's 2020." And they had no come-back. No response. Argument over.

There was an unspoken understanding shared amongst humans across social media. I watched as Christmas decorations went up right after Halloween. Artists releasing their new Christmas singles or even whole albums everyday. There is not only a need for Love, but a starvation for Hope this year. The same need and starvation that you find on the streets, in the shelters, and filling the jails on a daily basis, but it's been dwelling in the households, the school hallways, and the wards of the hospitals like never seen before. The world needs Love, and Hope and Joy. And as a nation, I see us reaching out to Christmas differently this year. 

I was expecting to be working the whole Thankgiving holiday, but for a handful of different reasons, there has not been a single transplant thus far. It's given our whole service a bit of needed rest. I took the time and challenged myself to work on counting my blessings. Sounds corny, I know, but truth be told, I'm ashamed to admit I have not done enough of that recently.

So I'm listening to Christmas, and acknowledging that I am blessed, and my future in the hands of my Saviour may bring me to even harder and more difficult years yet.

Estoy esperando que continúe la tormenta.

 The world had an anniversary this past week. Most didn't even realize it. It came and went unnoticed just as it did a year ago. November 17, 2019 was the first reported case of SARS-CoV2. Let that sink in, how the world has changed since patient zero.  Those infected. Those no longer among us. 

 How I have changed in that year. I did quite a bit of head-hanging today.  Inpatient admissions for COVID are becoming harder to ignore. Popping up on all services, and starting to fill the ICU beds once again. 

I want to continue ignoring it, but even with my head down, the smoke is noticeable. The smoke of a world on fire. It burns the eyes making them leak and cuts the heart making it bleed.

The transplant team has set and surpassed the record for livers transplanted in a year. I watch them; as they discuss their achievement. They get giddy about it. It's a carefully restrained high pitched excitement of fist-bumps, back-slaps and high-fives. I think.... I fear, they are getting greedy. They want more, and more. It's pushing their limits. They're tired. I worked last night as the transplant passed into the wee hours of the morning and I silently watched as they tried to convince themselves that the artery was going to be okay. Taking it down and redoing the arterial anastomosis would mean at least another 30-40 minutes minimum. The artery was not okay, and I kept waiting for them to admit it, but it didn't come. When I finally spoke up, the tide turned and we ultimately spent that extra time to fix the problem. I hadn't said anything they didn't already know, was maybe just that voice they needed to hear to break through their exhaustion and remind them of it. 

I wonder if we'll keep this pace through years end, or will our physical limits slow us down finally. Or.... will COVID slow us down. 

I'm betting it'll be COVID.

Much Love and Prayers

Estoy operando.

 

Photography is a hobby of one of my transplant attendings. Before he scrubbed in to join us, he amused himself for awhile. I'd say I got to benefit from it. :)

Much love and prayers

Estoy casi al fin.

 They say he's "on the edge", or "about to crack." Some are even nervous to go in his room, it just might be the moment that he attacks. You know.. claws out, fangs first. 

Really?.... our imaginations can get rather wild sometimes. He won't attack, but that being said, nothing about his inpatient course is going to be pretty anyways. He came to us paranoid, suicidal and homicidal. He flat out refused anything and everything, from making eye contact to taking his medications. Finger to nose, we called Psych. And they recommended a pill.... (blank stare)... for someone refusing all medications...  So, I explained it to the Attending. His pills, include his immunosuppression meds. If he refuses his pills. His body will reject his liver. And he will die. Him refusing his meds is essentially a suicide attempt. I got a light bulb finally, and they agreed to admit to inpatient psych. He started taking meds, and allowing labs to be drawn, which showed us that it was too little, too late. Liver was taking a swan dive from bad to dead. So he came right back to us for acute intervention and we subsequently slammed steroids and immunoglobulin into his veins as fast as we could. 

We talk about psych residents, joke how they have "banker's hours." They're the last ones in the hospital and the first to leave. Over the years I've had friendly relationships with multiple of the psych residents. Interesting to learn that they all have their own therapist. I never did quite understand why someone who could get more than 6 hours of sleep a night needed a therapist. But I think I get it now... if one single patient can literally drain the life out of you. Best to learn quickly how to handle those patients and yet maintain the plug in the drain. 

On a much less depressing side of things: I got my Letter of Nonrenewal. I signed it with a flourish and sent it on back to them. Much different place I am currently, than the last times I signed those letters as a prelim resident. My contract will not be renewed for the 2021-2022 year. I'm too tired right now to smile, but I feel a lightness inside, so I'll just say my heart is smiling as I say that.

Much love and prayers!

Estoy sobria.

 As we turned, and walked out of his room, he called after us, "I know how to hide a body!" 

He had been a homicide detective, and a good one. He prided himself boasting his impeccable track record, not a single open case left to his name. A pretty history and quite fascinating, I'll agree, but it covers up the ugly truth. The alcohol. What started as his escape became his crutch and the ultimate linchpin in the string of events leading him to us and that hospital bed. 

We all liked him. He was motivated and wanted to get better. Perhaps, maybe, we actually helped him. Here in New York that's not the usual story of alcohol cirrhosis. There never was a written rule, but in the past there was an unspoken requirement of 6 months sobriety prior to any liver transplant. We have not kept to that ideal in years. The main reason... these patients won't leave the hospital alive without a new liver. A ballerina. A lawer. A CEO. A father. A son. the list goes on and on. So... we transplant them, essentially providing a second chance at life. Once they wake up and their encephalopathy clears and they finally realize what happened to them.... we hope they are motivated and want to get better as our homicide detective friend. The transplant team I work with here will fight tooth and nail for these patients. They are determined to keep them alive, protect them, and support them. Will many of them go home and ultimately return to the alcohol. Yes, and it's a slap in the face....no, more than that, a kick in the gut. But it's the known risk of transplanting the patient who drank him or herself into hepatic encephalopathy oblivion. I hate alcohol.

One of our patients was transplanted for cancer rather than alcohol. He woke up from surgery feeling so good! Was in such a good mood that when we discussed the projected post op hospital course with him and mentioned going home soon. He was so excited he invited us all for a celebratory bottle of wine! I reactively froze out of fear for his future and the future of his brand new liver. Had to remind myself that a celebratory bottle of wine for this patient was just that and nothing more. Unclentched my throat in time to join in with a nervous half laugh, and subsequently was able to unclentch my fists before anyone noticed.  I wanted to smack him. Being honest, the term that came to my mind right then was "idiot".  Don't joke with a transplant surgeon about drinking alcohol fresh transplant, no matter what your etiology, they could have a heart attack! But smacking him probably wouldn't have gone over well, so I refrained.  

Love and prayers!

Estoy multiplicada.

 My return to work coincided with one of my co-workers leaving for maternity leave. Baby Arielle was born today, our newest member of W.O.W.!

There is a long story, and an unfortunate chain of events which I will spare, but it has culminated with me taking on my co-worker's service in addition to my own. The perpetual conundrum of the surgical resident... how do we be in multiple places at once? It's not the first time I've managed multiple services simultaneously. The first time I was only a prelim PGY2, so... a long time ago... and when I expressed concern to my chief, she shrugged me off saying, "you'll be fiiiiinnnnnne!" very obviously not worried about it. This time around, the roles are reversed. My team members look at me and concerned ask, "how will you do it?!" I shrug them off now saying, "it'll be fiiiinnnnnne!" And it will be, I've been a resident too long to think anything else. No, I still haven't figured out omnipresence, so I'll go to one place then the other, and so on and so forth. 

Yesterday we were back-up for a liver, when it ultimately went to a different institution I discussed with my attending how it's usually about 48hrs for the next offer, at least in my limited experience. He was not so positive in our prospects of another offer. It was then approximately 7 hrs later, middle of the night, and a liver was offered, accepted, procured, and I was in the OR working on the backtable preparation of our brand new liver for our patient. I refrained from tell my attending, 'I told you so.' 

Due to our new liver transplant, I had no time to prepare myself for morning rounds on either service. I guess that's why we have our teams, and everyone on those teams play a very important role. When I'm looking for my patient's fourth drain they can remind me.... this patient only has three drains. Mixing up my drains amongst services has to be semi-expected when one is post-call right?

Much Love and prayers!