Estoy de rodillas.

About to leave the hospital this evening, a last consult slides in. An appendicitis in the ED. I chart check, very straight forward. "Thank goodness" I think to myself as I walk to the ED. An easy case in the bag, and I contemplate, maybe I'll just stay late and do the case myself. That would be a fun way to end the year. Unfortunately, some personalities have a rather miserable way of taking something simple and making it extremely complicated. My appendicitis, for example, kept trying to find a way out of being appendicitis. I gave option A. and option B., so he kept trying to create a scenario in which option C existed. Rephrasing his questions, trying to catch me in a loop hole.  Which, of course, didn't happen. It really was too straight forward for that.  My appendicitis even tried to tell me he needed to think about it, and would go home and let me know tomorrow which option he wanted. This is when I start to become excessively blunt in my explanation of risks, benefits and options, because obviously.... something is not getting through clearly enough. Think.... option A: you live  vs  option B: you die...  level of blunt. Needless to say I did not get to finish out the year with a nice appy. I finally had to tag it out to my colleague, and it wasn't until hours later when he texted that Mr. appendicitis went with option A. (hallelujah! a decision was made.)

And now, as the year 2020 ticks its way into memory, I think back over the months on what could have been, what was, and now what will happen. 

I can appreciate the fact that we are living through history right now. The stories we will have to tell one day; fascinating, but definitely "you'd-have-to-have-been-there" kind of stories. And they will be stories I'll always carry with me, they are part of me now. Though I was not put here for such a time as this, God used it to teach me the lessons he needed me to learn. I may be a bit presumptuous in my past tense on the verb 'to use' as I fear I am still in the process of learn-ing those very lessons. But I'm running towards the new year trusting in God's faith in me to learn. 

There are three reasons for praise that immediately come to mind I have for the year 2020.

1. I have not spread the virus, and no one is sick because of me.

2. I have survived half of my chief year.

3. I have finally arrived at 2021.

In between those three, a million small blessings and the ever remaining constant... as constant as a new day is in coming, the love of a Father and Savior.

Psalm 113:3 From the rising of the sun unto the going down of the same the Lord's name is to be praised. 

Much Love and Prayer.

Estoy celebrando la Navidad.

 A few weeks ago I set a goal for myself. And after two weeks of productive studying, I rewarded myself by a trip to the city. Monica and I had a moderate list of coffee shops and bookstores on our list for the day. It was interesting to compare the emptiness of the city to my past visits, even during the holidays. For starters, the metro into Grand Central was almost empty. 

Monica & I at Bryant park. Three smaller trees instead of the one large tree this year.  

Coffee shop #1: Culture coffee

Would have been fun to sit here and enjoy our coffee, but as is, we contented ourselves with a picture and moved on. Perhaps next visit we'll be able to sit.

The Strand. Impossible to visit and not find 1, or 2, or 10 books you want to add to your collection.

Levain Bakery. Those cookies.. Worth it.

Not the only ones out perusing the bookstores of NYC that day!

Some coffee shops had longer lines than others, but when you have no schedule to keep just means you have that much longer to appreciate the sidewalk decor. 

A Chelsea Market Christmas

A Chelsea Market Christmas

NYC Christmas

NYC Christmas

 

The only place we did find crowds was Rockefeller Center. Nothing compared to the shoulder-to-shoulder of years passed, but probably too crowded for safety in the time of COVID despite 100% mask-wearing by all visitors. We appreciated our view from here.

 Merry Christmas! Wish you all a happy and healthy holiday!

Much love and prayers.

 

Estoy tratando dormir.

There a handful of uniquely significant people in my life. They inevitably were just minding their own business, and happened to cross my path at a point so divinely orchestrated that leaves me without a doubt that I am where I am today of no doing of my own. Olga is one of those individuals. She was our program coordinator, and retired this month.

Olga & I

I have often used the phrase, 'when a door closes, a window opens' and then put my own twist on it. Residency being the "house." Most US medical school grads are welcomed into the front door. I found the door locked, most of the windows as well. I climbed up a tree in the backyard to check one of the second floor windows back there. It was Olga that saw me hanging onto the tree outside that second floor window at the back of the house, and she cracked the window for me. 

During my year of research, my office was around the corner and down the hallway from Olga's. We crossed pathways often as the drinking water and the copier machine were located in my office. It was during the residency interview season, at the prodding of my research co-fellows, that I walked into Olga's office requesting a moment of her time. Two minutes later I walked out again with an interview for the general surgery residency. 

When a door closes, a window always opens. Just sometimes its a second-story window in the back of the house that someone left cracked just for you.

My chief year I've altered my path into and out of the hospital every day. I pass through the lobby of the Children's Hospital. Despite it being probably the funnest place on the whole campus, it's also usually one of the quietest, especially when arriving and leaving before and after most others. Ever since COVID, all of the chairs and couches have been removed so it's just an open area now. I'm glad they still decorated for the holidays!

There are a few items of decor within the Children's hospital, that puzzle me. This face is one of them. It graces the wall above the main entrance for the lobby of the Children's Hospital. I think it's supposed to be a moon... but it strikes me more frightening than anything happy or otherwise child-friendly.

How many chiefs can you fit into one case? Ash, Ansab and I found ourselves all scrubbed in on a case the other day. Vasu had left that morning post-call, and was technically on his vacation. We joked that we needed to call him back in to scrub so we could retake the picture with all four chiefs. 

I finally got my first COVID vaccine today. They are making appointments for everyone in the hospital, but due to my schedule being subject to change often multiple times daily, it's very hard to adhere to any appointment. So I went as a walk-in on a day off. The check-in process was quite extensive. Opposite of the yearly flu vaccine, which everyone is so used to, its almost automatic. I understand that the long list of questions is necessary for research purposes etc. But when she asked me, "Have you had contact with anyone positive for COVID-19?" That was taking it too far for me, and I could feel my patience start to escape. I don't exactly know why it upset me so much, but I had to reign in quite a few short retorts to her question, before I could safely respond and move on. 

Much love and prayers!

 

Estoy cansada.

 "I'm tired." I confessed to my attending. We were finishing up amputating a few toes last night, and I could have closed my eyes and fallen asleep right then and there. I hadn't had time to refuel with coffee throughout the day, so it was almost midnight, and I was just... tired. 

It's been full the past couple of weeks. Extra call due to my co-chiefs being gone. Busy in the OR. Dealing with unhappy residents, and passive aggressive attendings. Transition of services. I am now chief of the Acute Care Surgery service (a.k.a. emergency general surgery). Making it on time to all of my zoom interviews for fellowship, post-call hair and all! Each of these topics I could unbottle about, but time has demanded me to keep on moving, and thus I resort to the above sentence fragments and summarize them with "I'm tired." My attending nodded in agreement to my confession last night as my physical clinical presentation at the time reflected that description. I didn't elaborate beyond that, and let him believe it stopped with my needing a nap. 

I had another candle lit in heaven last week. Next confession: I struggled with... am struggling with this one, more than usual. It wasn't the first patient I had die, and won't be the last, but it was much more humbling for reasons that I won't elaborate on such a public forum. 

Medicine has an uncanny, and at times, almost brutal way, of keeping me humble. I'm left analyzing my efforts to perform what is physiologically right and technically perfect, are they all for nothing? My desire to help and not hurt, again is it all for nothing? 

I confess to myself, as much as I confessed to my attending, and I confess to you now. I am tired. I am not perfect. I am lacking, and I have need. 

I confess out of an effort of self-help, that I can come to accept my newly lit candle with respect rather than fear, and that I can keep it safe. 

I find it harder to stand up for my team and my patients as a leader and chief resident, when I know the truth to be as I confessed above. Makes me wish it could be June 2021 already that much more, but alas time only passes one day at a time. So I pick myself up, I smile, and I keep going, trusting in God's wisdom and Jesus's love. 

Much love and prayers.

Estoy tomando agua.

If you walked into his room early morning, you’d form the snap clinical picture of a harmless elderly debilitated gentleman who was unaware and unoriented. But, you’d be wrong. You see, as you were grabbing a pair of gloves from the box on the wall he had cracked his eyelid, just long enough to register who had entered his room, before closing it tight again having decided if you were worth his attention or not.

I quickly had caught on that he was, in fact, appropriate…. Just didn’t like mornings.  Kind of like a teenager who grunts in response to questions he/she doesn’t want to answer, he would grunt. Sometimes he’d crack his eyelid to stare at me a moment or two, maybe contemplating if it was a question worth responding to, before closing it again and delivering his grunt. Some mornings were better than others, and afternoons infinitely better than mornings. But even when most tired, he never avoided my questions, even his grunts would be in either an affirmative or negative manner.  

There’s no denying he was a sick gentleman, but after awhile there was no further intervention we could do for him at the hospital. One of the many limiting factors in his care, keeping him fully dependent on others, was his inadequate nutrition. If left alone, he would never eat enough. Grabbing his cup of water and holding the straw to his lips every morning he would oblige me and drink. Even grumpy in the mornings, he still wanted to be able to leave the hospital, and he understood that my cup of water every morning wasn’t to torture him. He had to prove he could maintain hydration to leave, so he would drink, sometimes without even opening his eyes for me, but he would drink.

One morning as he drank the water I held up to him, I went through my usual reassurances and encouragements. Unfortunately, my tongue got tied and I told him to “make sure it doesn’t go down the wrong poop.” Fumbling embarrassed, I tried to backtrack and correct myself, but then stopped as I looked at him. His eyes were wide open, his mouth cracked open in a long and hearty inaudible laugh.

You know... he’d never admit it, but he’s going to miss me waking him up super early every morning. Maybe, I’ll miss him a little bit too.

Much Love and Prayers.