Estoy entera.

 "They're dropping like flies." The exact phrase one of the hospitalists used to describe our current state of COVID in the hospital. "It's worse than ever, even the first wave." Another paraphrase from one of our PAs. The restrictions on elective cases have already been prolonged. And my emergency cases are coming through with positive COVID results again. Walking down the hallways the tables of PPE outside patient rooms are increasing in number. Our ambulatory surgery area of the hospital has been transitioned to hold our overflow of inpatients. 

I do have a different perspective than my colleagues, so don't notice that our current state in Indiana is in anyway the level of strain COVID put on the system now almost two years ago in New York. But it is still that. A strain on the system. Stay safe my friends. Protect one another and care for your neighbors.

I started booking my cases as robotic. It says something if you are persistent. They either got tired of my pestering, or annoyed with my repeated texts, but either way they stopped putting up the hoops and let it go. Ha, just to illustrate how much of a mess this has been, because of the fuss caused by my simple request to use the robot they ultimately had meetings to rewrite the DaVinci requirements. And currently as the rules have been rewritten and sent to the powers that be for approval, no one can actually tell me if the old rules or the new rules need to be followed. So I just keep my head down and do surgery, it's all I want to do anyways. Let them fight about the rules, I'll stay in my bubble and do surgery. I'm happy. Not so sure about them.

I think I am finally doing better from a caffeine withdrawal aspect. I expect more time before my energy level returns to its previous level, but I am not feeling so awful anymore. 

I did have some coffee for Christmas. But look at this...

Christmas morning at my parent's home. Just wouldn't be complete without a cup of coffee! 

Granted, I returned to work on Monday and struggled with headaches again for a few days. But they were short lived and it was worth it. It also tells me that I'm not quite there yet. My goal would be to be able to have coffee or not have coffee, and not worry about being sick, whatever that decision may be. 

The first to join me by the fire Christmas morning. It took very little prodding for him to go wake his brothers in order to open their Christmas stockings!

Heading out for a walk after the festivities calmed down. We just about missed the sunset.

Estoy disfrutando las luces.

 As we are in the midst of the Holiday season of 2021, I am starting to look around and appreciate, maybe even for the first time, where God has brought me this year. I don't know how long exactly, but I had slipped into a robot survival mode sometime the last two years of my residency. A part of me had done so consciously, and did it in order to "survive." What I didn't realize at the time or during these past two years is perhaps, just how deep that forced facade had impacted me. Even to the point of preventing any personal growth. It's been an interesting time in Lafayette thus far, but dare I say I feel as if I am finally beginning to settle a bit and appreciate the opportunity for restoration, and hopefully growth again finally.

 A few of the "young professionals" went to take in the Christmas lights at Newfields in Indy. L to R: Andrea Furrer, Julie Lanz, Tyler Tonner, Callie Furrer, Nicole Bauman, me, Joel Luthi

Christmas lights at Newfields

Christmas lights at Newfields

Our work Christmas party (a few are out of view of the camera unfortunately). Fun evening of food and conversation. After dinner we stood in a circle and sang Christmas carols and presented a few gifts. I am still amazed at the opportunity I have with this group to openly love Jesus, and know that I am not alone, but amongst brothers and sisters. I may travel the world one day, who knows where this life will lead, but I'll never again find a such a unique blessing as this team.  

Much Love.

Estoy saltando.

 By the time I had finished residency, I was comfortable on the DaVinci robot. Repaired different types of hernias, removed gallbladders, resected colons and stomachs, removed tumors (adrenal glands, livers, etc), resected lung, plicated diaphragms, etc. and I'll admit I liked using the robot. You loose the tactile sensation that is so vital at times to discern appropriate planes, so it has it's faults, but the benefits are worth it. Finishing up residency, I was even willing to stay until 11pm post call to get that one more last robot case in. But leaving residency I honestly willingly put the robot out of mind as I did not see its usefulness in my future. Upon my request, the team here in Lafayette has started giving me more coverage which has included back-up coverage and subsequent referrals for elective cases. I quickly realized that even if for the time being, I should revisit the idea of using the robot for many of these elective cases. Talk about an unexpected can of worms. My request, though supported by all of my partners, was met with obstruction and some rather angry passive aggressive emails. It caught me off guard, and I still don't really understand why as I see it as common sense when I can offer a patient a better surgery with the robot.... to then offer that patient said better surgery with the robot. But I put my head down and started jumping through the array of hoops thrown at me, lots of hoops. I have my first robot case finally booked, but am not going to believe it until I am physically sitting at the console moving the arms. At the rate things have gone thus far I would not be surprised of further obstructions arising. 

Speaking of elective surgeries, our hospital has cancelled all elective surgery that would require an inpatient admission post operatively, at least until January. There are physically no beds available in Indiana, and ED's are filling up with patient's needing admission, but with no bed open to move them out of the ED to the floors or ICUs. This makes ED wait time long, and just globally increases frustration and inefficiency for all parties involved.  If you're wondering, yes you can blame COVID, no it's not going away.  It recently affected our surgical clinic offices, but thankfully everyone was vaccinated and able to wait out quarantine at home with manageable to little symptoms.

Much Love.

Estoy quitando cafeína

 I hit the breaking point I didn't know I had. As is typical with breaking points and rock bottoms, hard to predict their location unless you're right at it. It had nothing to do with me of course, but rather my ability to do my job. I'm talking about coffee, specifically referring to the caffeine contained within coffee and its addictive properties. 

For whatever reason, I am very sensitive to caffeine, both for good and bad, and known this since medical school. Good, caffeine has the desired effect of waking me up and helping me focus through that 3am surgery. Bad, if I don't have the usual daily dose I get pretty sick. The last time I can remember not having morning coffee was before residency, when I had on purpose weaned myself off the drug in preparation for the rest of my life. But since then I've enjoyed coffee every morning, knowing full well the physical dependency my body was developing. It fueled the strings of 16 hr work days broken up with 4hr nightly naps that came with the responsibilities of surgical residency. Helped me study that extra hour, and helped me restart my life after crashing post call. Then a few weekends ago I had one of those calls that required I hit the floor running. By the time I could come to a pause it was late evening and I hadn't had the time to drink any coffee, and at that hour I needed to be able to rest. So I took the risk and did not take any late evening caffeine in order to sleep. I tried to compensate the next day, but it was too little too late, and I had to ultimately go home and let my PA finish what was needed on my patients. Not being able to fulfill my responsibility to my patients was my breaking point. This physical dependency my body has, for better or worse, is not worth not being able to do my job. 

Cold turkey was obviously not an option, as it would render me useless and unable to fulfill my responsibilities. So its been a painful slow wean, meaning a daily headache, but just the right amount of headache that I can still work and find relief with ibuprofen. In summary, it's not fun, and ultimately has provided me with perhaps an appreciation and understanding not previously held for those in similar situation, given whatever their personal drug of choice (alcohol, nicotine, opioid, etc). I mean, can I ever just meet a friend for coffee again? I'd like to say yes, but let me survive the rest/worst of this withdrawal first, before I fully answer. Eventually I want to confidently know I can do my job either with or withOUT caffeine, and then stay that way. 

I don't want to give a lopsided view about my calls. They can be rough, as previously described. But on the other hand, I had a call the other night and the pager didn't go off a single time all night. Granted that is rare, but not every call has me running like crazy. Unfortunately it tends to lean one way or the other, rather than an even distribution of the work steady throughout all calls. Its more like a pendulum with huge heavy swings one way or the other. It's hard to predict which way the pendulum swings; weather can lend a prognosis, but it doesn't always hold true. Over time you somehow pick up a feeling, almost a foreboding of which way the oscillation is pointing for the day, but up until the alarm goes off to start the day, nothing.

Much Love.

Estoy agradecida.

Thanksgiving finds me in Illinois this year. It was debatable pending how call treated me these past couple of days, but Wednesday morning found my list with only one remaining inpatient which required minimal input from a surgical perspective and therefore lessened my qualms about signing out to my partner appointed for call this week. This is the first time in the past 13 years I am within easy drivable distance of immediate family. I am thankful. 

I finished up my clinic, took care of errands, supplies for a Friendsgiving when I get back and a few other odds-n-ends before packing up my car and heading to Gridley. With all of the concern about delays in shipping continuing this year, I've completed most of my Christmas shopping already, hence why it took some time to pack up my car. That also makes for a rather confusing Thanksgiving as you don't typically wrap Christmas presents next to pumpkins and orange leaf decorations. But times are changing, and there's nothing wrong with being prepared. I am thankful. 

I was also thankful to find one of my clinic post op patient's doing well. I removed his staples and finally gave him my blessing to make the trip down to Florida, something he'd been asking for since before the surgery. This particular case is one that will stay with me for awhile, for a rather particular reason. It was a rather straightforward case, but with potential difficulty, and none of my partners or the techs were going to be available to assist me, so our PA had faithfully gowned up and stood opposite me at the operating room table. She had been nervous, but did a great job and thankfully the case went well. The recovery went even better. Don't tell the patient this, but I actually kept him in the hospital an extra day, for his own safety. See, he was doing so well, I didn't trust that if I let him go home he'd continue to take it easy, but start to try to pack up his RV. Hence his perpetual question of when he can go to Florida? It was during one of my visits to the patient's room that his wife and one of his daughters had been present. Conversation was typical concerning expectations and recommendations concerning the future. At one point, I discerned their desire to have contact information, and handed them one of my business cards. What surprised me was the reaction that act received. Our conversation actually had to stop as the wife and daughter took the card and could not focus back on our exchange until they had found a sure and safe place to keep that little piece of paper. I kept my poker face, but truthfully the reaction made me a bit uncomfortable. As fun as it was to see my name on a business card for the first time a few months ago, this was the one and only time I've actually handed it out. It makes me ask, what is my business, and why is it important to people?

To further illustrate my internal debate, the above exchange coincided with something I read in a book about Mother Teresa. She had been given a business card once, loved the idea so much that she had her own business cards made. 

The fruit of silence is prayer.

The fruit of prayer is faith.

The fruit of faith is love.

The fruit of love is service.

The fruit of service is peace.

 Her name wasn't on her business card, just her business was. The business of Jesus. What is my business, and why is it important to people? What should my business card actually say? "I love you, and Jesus loves you" or "John 3:16 For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life."  And then this leads to my next question, would I ever have the nerve to not follow socially acceptable norms and actually use such a business card? That family has no idea what kind of internal conversation/debate they sparked within me, but we usually never do know our effect on others. Hence why we should always try to be about the business of Jesus!

Much Love, and Happy Thanksgiving!

 

Estoy descansando.

 Finished another call week. It's a nice system the practice has in place. But like any system, there are pros and cons. One surgeon is primary surgeon for an entire week. Pro: it leaves Sundays open for the majority of the group to attend church and spend time with family, etc. Con: For the primary surgeon, the burden of this lays heavily on the weekend when that one individual is taking first call for 72 hours straight. I came to a point during one of those 72 hour runs, at about 44 hours in without any rest, that I said outloud to no one in particular, "I don't know if I can do this for another day." I was being rhetorical, as I knew that I would do whatever was needed. But God heard me anyways and calmed the storm, and I was able to rest and finish that last 24hours with a smile.  Looking back, I do kind of judge myself for being so weak, and I know there was a element of fear in my sudden outburst. I had just been paged yet again about a complex surgical problem at a hospital over an hour away, and my tired brain had struggled to filter through what information was being given to me over the phone in order to make a decision. I don't know what will be asked of me in the future, but it may be that I look back on these times and laugh at my weakness to manage.  I must trust the grace of El Shaddai to be there when the patient needs a decision or pair of hands for Him to work through. As always, He leaves me no doubt that I could never have done any of this journey on my own. 

Laughing with one of my partners this morning, I confessed that I never thought I'd ever be so excited to see Monday mornings as I am after finishing a week of call. I love what I do, but there is a mental exhaustion that comes with making sure I am ready to respond at all times for 72hrs straight. And tonight I am thankful to leave my pager hanging on the wall by my door and be able to put both of my earphones in with the music playing too loud and not worry if I'm missing anything. 

Much Love.

Estoy parte de comunidad.

Community: a feeling of fellowship with others.

Our communities are very commonly defined for us, either by geographical boundaries, religious beliefs, language, and education are just a few easy examples. Then some communities expand beyond borders and can span across language or even time. Those communities can have an elephant effect on our culture, our country, and our world. But very frequently, and I know I am guilty of this, an individual's role in such a community is non-committal, for better or worse. On the other hand, some communities are close, small and the immediate spheres through which we live and work on a daily basis. Finding these communities and moving between communities has a strong impact on our comfort and our happiness as they give us a sense of belonging. And with belonging, we receive a sense of responsibility for each other and the importance of maintaining connection with each other in order to preserve this validation of who we are.  

When one moves to a new geographical location. Those smaller and immediate spheres of community have to be rebuilt and developed from the ground up. As an Apostolic Christian, one of those spheres, and arguably the most important, is ready and waiting. It helps with the daunting process of rebuilding the rest. My most recent move to Indiana presented me with a few new challenges as I worked through the process of finding and developing my new communities. 

This move is the first time that I am in a geographical location in which there is an overlap between my work community and my church community. I had up to this point, always been able to safely separate and disconnect those two worlds in my mind and my life before. It was also the first time in my life that I found myself standing at a starting line with no one to my right or left. No fellow classmates, or no co-residents in the trenches with me here. It's a new kind of alone. 

Thankfully, I know I am never alone, and honestly we are all searching for community. However, these new challenges have got me appreciating even more all past communities and relationships with which God has blessed my life. Some God used to drastically change my perspective, my behaviors and my life. I am who I am today because of these communities. 

This past weekend I was able to visit with Regg & Bev Beer and their tribe. Regg & Bev were my brother and sister in Ixtlan. Regg & I were in Mexico for roughly the same four year time span, Bev moved down for the last two years after they were married. Honestly, they probably wouldn't be able to shake me even if we only knew each other as general acquaintances through A.C. connections; they are just that kind of awesome. But when you can start a conversation with "Remember that time in Mexico when..." "Remember the tacos at the plaza..." "Remember when Jan..." Thankfully they let me keep dropping by, and even though my last visit was before the pandemic, the older boys are starting to remember me!

Two baseball players, a superhero, a pumpkin, and a cow. Between my sister's and these guys, I got to experience Halloween like a little kid this year. Very fun surprise!

Tucker, Cooper, Colton, Trace & Boyd. Not too many obvious differences between these two pictures. But I loved them both for one particular reason. In the picture on the left Boyd has his adorable little smile, while on the right he has a very characteristic facial expression in which he raises his left eyebrow. Before he got used to me, he'd walk around with his left eyebrow cocked as if he had a perpetual question, an expression I saw much less as the weekend continued.

Trace didn't remember me from my last visit, but I hadn't been in the house 5 minutes and he was crawling up my pant leg to sit with me on my stool. Such cute little buddies.

 

 

Guess how much time between above and below!  Bev & I.

 

lol, above = Indiana 2021, below = Guadalajara 2010. 

Much Love.

Estoy empezando al principio.

 I've taken up a new hobby since my last post. Growing marker bouquets.

Granted, starting out slow, but I think soon I shall have to try thicker font, and then maybe I'll start expanding the color selection. But I figure if I'm going to go back to the beginning and start all over again from scratch, might as well do it properly. 

Our office likes to use birthdays as an excuse to have the office purchase lunch. A monthly tradition no one argues with, consider it team building. They were especially excited I had a birthday in October as it was the only month without a birthday, and thus I gave them a reason to have a party! I didn't get everyone in this picture, as you can imagine hard to get a busy practice at a time when everyone is able to sit down together. L to R: Tish (tech), Ruthie (unofficially helps me during the day when I need it), Dr. John Francis, Katie (PA), Cindy Ann, Cynthia, Marie (tech), Nancy (she put the party together and even baked the cake), Jody (tech)

When visiting my sisters a few weeks ago, Miles disappeared after church. We eventually found him in the last place we thought to look. Cashed out on his bed, one shoe off and one shoe on, diddle diddle dumpling.

Taking my nephews on my birthday Starbucks run!

Pumpkin carving with the nephews!

 

Random view from behind my apartment building. Just cause. :)

Much Love.

Estoy tomando mi cruz y siguiendo.

No clever intro for this one. Been staring at the cursor for nigh on 10 minutes at this point with no progress. Might as well rip the band-aide off.

I received my results yesterday, and "It was the consensus of my examiners that my performance during the examination was not at the level required for certification."

Ouch.  I've been here before, that bitter taste of failure. The feeling of ridicule from the surgical community. Being not enough, not good enough, and the worst, not safe enough. As you can imagine, Satan can take these lies and wreck havoc. 

But it wasn't failure, or even Satan, that I struggled with this time. It was finally admitting fear. 

I stared at my screen with its red FAIL clear and well illuminated. Maybe if I blinked enough times it would magically change. But it didn't, and with shoulders slumped in admitted defeat I faced the fact that I had to do it all again. He turned me then, gently, but He turned me to face what I had put down two weeks ago. His instruction wasn't harsh, wasn't severe, wasn't even chastising, "Pick it up again." That's when I cried. 

We all have our crosses to bear. They come in all different shapes and sizes. Some so heavy and carried for so long, that we feel we can't make it another step. But truthfully none bigger than what we can bear. Yet, in that moment, in my weakness, I couldn't jump to pick it up as instructed. Instead, I looked at it face on for the first time in my life, and He didn't chide me for pausing, He stayed next to me patiently waiting as always. I can't explain exactly what I saw through my blurred vision, but for the first time I was able to see it for what it was. Fear. 

No, I do not think God wants me to be afraid. But I do think that He wants me to know Him as El Shaddai; The All-Sufficient One. Living on my own for many years now, and taking it one day at a time. I carried my cross as bravely as I could. Bravely, unfortunately, in my dictionary ment without acknowledging its presence. I had to be tough. And again in my dictionary, tough ment without fear. I think it's time I find a new dictionary. Because I am afraid. Afraid of speaking. Afraid of saying the wrong thing. Afraid of making a poor decision. Afraid of hurting someone. Afraid of making it to the end and not hearing those words "well done, thou good and faithful servant". And where I am afraid, I am weak.

2 Corinthians 12:9-10 And he said unto me, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me. 

I never despised a verse before, but last night, as a few friends and I discussed El Shaddai, this verse filled me with a sense of alarm, almost as if I'd never actually understood it before. In that moment, I would have rather done almost anything than to glory in my infirmities, my weaknesses and my fears. And with shame I wondered if I had ever. Recognizing my nothingness in service of my Savior is one thing, but my walk.... I was very purposeful about keeping my shoulders back, whether that was down the street in Mexico, or through the hallway in the hospital, or preparing for my oral board exam. 

So taking this cross again, I do not know where Jesus will lead, but I will follow. I am not about to think that by admitting fear, will erase fear. It may be even more daunting this time, as should I fail, I'll be left with only one more attempt. Stakes are higher. But by acknowledging it, does help me accept it, and then maybe I can learn to live with it, and dare I say even glory in it. 

Much Love.

 

Estoy tomando cafe.

I'm glad I ran with the momentum spurred by the post-oral-board-surreal high last Monday and put down the previous blog post. It was after I finished that post, I unfortunately, made a bad decision. Granted wasn't aware how poor my decision would be until it was too late.  I had decided to list the case topics I was given during my oral boards. Just for funsies, you know, to share with colleagues in the future, or potentially for future studying etc. As I recalled each topic, naturally the case replayed in my head, and one by one I started to realize everything I had said wrong, mismanaged, poorly staged and by following the corresponding algorithm, offered incorrect treatment. The process had an effect that snowballed into an avalanche and that surreal adrenaline rush ended as fast as one would plummet off a cliff. There it was! There was that disappointment I had been expecting! Hello, old friend, and oh-so-reliable, loyal even. 

Having my normal post-exam despondency renewed and intact once again. I set about seeking to fulfill the typical need for distraction that goes hand-in-hand with such despondency. 1) Started into the pile of books I've had on my reading list for years. Even took out a library card with determination to make a dent in said list. 2) My partners, responding to my request for additional responsibility, have entered a new contract with a nearby community hospital. Now is a bunch of paperwork to expand my privileges to that hospital, and then starting in November, Lord willing, I will be covering clinic and outpatient surgery there once a week. 3) Last but not least, attempting to make it through my hastily dumped pile of mail, bills, license renewals and the like which had accumulated over the past couple of months, ignored on the principle that studying and focusing on my boards took priority. 

I would have loved to fly away as part of my "distraction" and explore a new corner of this world, but honestly, by adhering to my existing call schedule in Lafayette, with the additions of the distractions listed above, there really wasn't much room to give any extended way to despondency. In addition, I was able to visit Illinois to see my nephews for my birthday. Happy birthday to me!

Much Love! 

Estoy libre.

 Laughter. That was my reaction to the dramatic finish of my oral boards. 

Not quite sure what I was expecting. Dread maybe. Disappointment probably. But definitely not laughter.

I had struggled a bit on my last case. Taken my patient to the operating room and performed a surgery but before I could leave the OR my examiner kept asking me the same question, just rewording it three different ways. My answer was the same management each time. I couldn't get what he wanted, or what I was missing. He finally lets me leave the OR and I continue management in the ICU. He fastforwards my timeline to hospital day 10, at which time I then decide to trach my patient. His voice jumps a full octave to exclaim, "Ok, thank you!" and he immediately leaves the zoom meeting. I cracked up laughing. I couldn't help it. I had no idea how I had done. But it was over. 

Was the laughter from relief? Was it from the dramatic flare of a finish? Or have I finally officially driven myself crazy over this? Combination of all three?

Once I stopped laughing, the most surreal feeling began to set in. I have dreaded oral boards for the last 7 years. As a prelim, when I was 99.93% sure I was not to have a future in surgery and felt like my heart would break at the idea. Trying to grasp at any positive thought, one of the very few I could find at the time was 'at least I wouldn't have to stand for oral boards.' Ha. Such distant memories now. God is good, and I was blessed to be able to continue in surgery. Every day I performed a surgery, every day I studied, every ABSITE, every day in preparation for the future, in preparation for oral boards.

I honestly can't say right now if I feel like I passed or failed, it's pretty complicated, and this surreal feeling is rather overwhelming at the moment. There is one thing I know though, for which I am incredibly thankful, I didn't freeze during the exam. 

I suffer from a rather annoying disorder that causes my brain to blank when I am asked a question. Doesn't matter if I know the answer or not, because in the moment, I am left with nothing. As you can imagine, it fuels a bit of preexisting anxiety and dread of presentations. Hence my reference of M&M presentations in the last post.  I always had to view them as oral board practice to prevent myself from running in the opposite direction. It was my principal fear facing this exam, not being able to say anything, and those quick seven minutes per case flying by before I could even give a patient a fluid bolus let alone diagnose and treat. 

But I didn't freeze. I was able to talk, to respond, to answer. I will find out in a couple of weeks if those words/responses/decisions were deemed safe and acceptable. But for now, I am thankful. I know there were many prayers said on my behalf for this exam. I felt every one of them, and know they are the reason I was able to speak. 

Much Love.

Estoy tomando cafe.

 My life has been looking a lot like a coffee shop lately. Hood up, earphones in, computer open, hot cuppa in hand. One could loose sight of me as I fade into the surroundings. My call schedule has been rather light as of late. Originally I had attempted to alter that, offered to take my partners calls, etc. But nothing seemed to result from my efforts. Now with oral boards less than two weeks away, I appreciate how wise my Savior is, even when I lack the understanding. In other words, I'm no longer pestering my partners to take their calls, I'm spending what time I can to study. I'll be honest, the oral boards is giving me severe Imposter Syndrome. I took a Mock Oral exam the other day. Couple things I realized. 1)There definitely is a right answer  2) Even if you give them the right answer, they'll still throw a curve ball at you next  3)There isn't any time to second guess an answer

I finished my mock oral and immediately started texting my old Attendings from back at Westchester, asking if they would be willing and available to give me more mock orals. Thus far they've been willing. One of them offered that he could do it right then. I could have, but at the same time I couldn't. Which I didn't even attempt to give a reason, just responded that I wasn't available at the moment. Maybe mentally unavailable, that way it wasn't a lie. And then hating myself for being such a coward, I went for a run. 

You'd think with all the interviews and 'first days' I've been through, all the M&M's I've stood up and presented, and all the patients I've introduced myself to, it should have gotten easier along the way. And it did, it definitely was easier at the end. Just doesn't feel like it right now, but I can't imagine facing orals without those seven years of M&Ms under my belt first. 

Cafe Literato

Fuel at Five Points

Fuel West 

I wasn't joking before. Totally left more than one butt imprint in the faded red cushions on those chairs. There's also a Starbucks or two in the mix. Depends on my mood that morning, and where I am in the rotation of coffeeshops. Can't visit a single one too often, someone might come to recognize me, or worse, expect me! Oy vey, that would be too close to conversation for comfort! ;) j/k

My oral board exam is scheduled for Monday Oct 11 in the afternoon.

Much Love.

Estoy aqui.

 It is a truth universally acknowledged, that Mid-Westerners are nice. It happened often in New York that, when finding out I am originally from Illinois, I'd get a response along the lines of "figures" or "I was going to guess that!" And honestly, that was probably prompted, just because I had said "please" or "thank you" or something along those lines. Which just goes to argue that it takes very little to be nice, and the World could benefit from more of it. But that'll quickly take us deep down a different rabbit hole, so back to the population of the MidWest. Yes, it is generally true that everyone is nice here in Lafayette, IN. Of course, there are your outliers, but I have yet to meet them. Seriously, even my drunk trauma patients, politely ask if we serve any beer. (*facepalm*). 

There is a phrase I have heard often these past two months. I find it funny, because I can remember the phrase used in general conversation growing up in Illinois, and never once thought anything about it. But I never heard it in New York, and it hits me every time now. "There she is" It is used as a greeting, replacing the generally accepted "Hello" or "Good morning," etc. It is usually said with an emphasis on there and the is drawn out like isss. "There she isss" It is the most popular greeting I get from patients, sometimes when I walk into their hospital room, but definitely when I walk into the exam room during clinic. I'll be honest, it caught me off guard initially. And it caused me a bit of distress as I half-panicked over-thinking the phrase and what they could have possibly ment. I mean, they had come to clinic to see me, where did they think I was going to be? And quite honestly, I know their insides pretty intimately... did they really think they could get rid of me that easily? Truthfully, at first I wasn't quite sure how to respond. But after its repeated use, always said with a smile, I began to realize my mistake and that my hesitation and concern was unfounded. They are, in fact, just saying "Hello" (the *facepalm* is for me this time).

There she is. Ha! Tickles me every time now.

Much Love.

 

Estoy pidiendo.

 There was a coldness in the room that presented itself like a frigid shoulder when I walked in. I was there, more out of formality, I could have offered the plan without physically seeing her. But as I introduced myself, my usual attempt at reassurance did nothing to penetrate the fear in her eyes. Her mask, a meager half attempt, served more as a distraction as she focused on drawing in her next breath of oxygen. I conducted my interview and spoke to her, doing my best to maintain that afore mentioned level of reassurance. But I'll admit, I was one quarter distracted by her mask which refused to stay put, and three quarters distracted by her nurse. Dressed in full PPE, she busied herself in a flurry of movements doing her best to keep her back to us, and when she was mid-turn, took care never to make eye contact. But with that brief look towards her face I didn't blame her for keeping her back to us. She faithfully carried out her job, but her face betrayed her. In that brief moment I glimpsed a mask I've never seen before, and struggle to describe. It was the source of coldness filling the room, and tension, made thick by a combination of hurt, hate, and frustration. As I renewed my attention to wrap up my interview, I could not find a shred of understanding in her scared eyes. She had no idea what she was causing to rise up in her nurse. Completely clueless to how her actions were affecting those around her. Completely self-focused without understanding how her community on a grander scale was affected by her. I finally stripped my PPE and exited.

Let me describe this in a different scenario taking any and all viruses out of the picture, because there is so much false information and conspiracy out there that it's not at all surprising that Dick and Jane can't tell Spot from ball or up from down anymore. 

Let's look at alcohol. There are laws in place which we as citizens must abide by. There is a drinking age and a blood alcohol limit. Where did the age of 21 come from, or a blood alcohol concentration of 0.08 come from? Or better yet, why were those laws needed? They were advocated for and put into place for protection of not only the individual choosing to drink, but for every person around that individual as well. They were put into place not only to save the life of the individual choosing to drink, but to save the life of every person around that individual. That law was put into place not out of a desire to restrict, but a desire to protect, a desire to prevent death not only for the individual, but for every human being surrounding that individual. A desire to protect the community as a whole. Now we are the land of the free, and boy do we love our freedoms. We love our freedom so much that we almost daily exercise our freedom to stand up and demand more freedom. And more. And more. We are so incredibly free that we have the freedom to disregard the laws countless mothers have advocated for and drink under the age of 21 and beyond the bac limit of 0.08 and then drive. And because we have that freedom, a mother will never get to hug her 4 year old son again. And because of that freedom, 74 year old grandma and 75 year old grandpa will eventually be able to leave the hospital, but only by living out the last of their days in a nursing home. 

Our government respecting our demands for freedom is a huge blessing. And with huge blessing comes huge responsibility. The protection of our communities, of our neighbors, of our families and of the strangers we pass by on the street has now become our individual responsibility. I would be the first to admit I struggle with selfishness, but we are. We as Americans, because we live in such a blessed country, with freedom, have become so unbelievably selfish that we don't even realize how selfish we are. We are blind to how living in a community is affected by an individual decision. Whether its a decision to drink and drive, a decision to buckle our seat belt when in a vehicle, a decision to pay our taxes, or a decision to wash our hands with soap after using the restroom. It's never just about you. It's about community. 

It's never just about you. It's about community. If not for you... do it for that nurse. 

Talk to me.

Much Love.

Estoy lista para Septiembre.

 No one ever said it would be easy. I wasn't expecting it to be so. I was thankful for a gentle start, but knew it would end. Maybe... I wasn't expecting it to end quite so soon. There's a handful of cases I have to thank for the growing ulcer in my gut. 

There is a new and overwhelming desire I have to heal my patients that was not previously there. I can do my cleanest and quickest work, my best work, taking care to set up the conditions to give each patient their best chance to be successful at recovery. But then we leave the OR, and I have to let them go. I have to trust that they will heal, heal well, and return home to their loved ones again. 

I'll go over their numbers multiple times a day, checking to catch any less then ideal value, and fix it. Again, doing what is within my ability create the optimal conditions in order for them to be successful. But what I really want to do is beyond my power, I can't heal for them. I expressed my conundrum to my partner the other day, and all he had to do was nod. He then inquired as to the current state of my ulcer diathesis. Something tells me he remembers being in my position all too well. 

There is only one conclusion. 

"for I am the Lord that healeth thee." Exodus 15:26

"For I will restore health unto thee, and I will heal thee of thy wounds, saith the Lord;" Jeremiah 30:17

I am glad that August is over. It has been good. It has been humbling. 

I pray that God can continue to mold these hands to do his will, to do his work, and then permit me to entrust our patients to His perfect care. 

Much Love.

Estoy empezando estudiar de nuevo.

Received a bit of good news recently. Brought with it a momentary bit of peace amidst the burdens our world continues to struggle with. I passed the General Surgery Qualifying Examination (a.k.a. the written boards). God is faithful and continues to provide. Having passed the QE, I am now able to register and take the General Surgery Certifying Examination (a.k.a. the oral boards). Lord willing I will take it in October. Shelling out another $1500 I had to wonder at the masochistic motives of my predecessors that set up this system. Because please, let me pay half of the world's GNP, so that I can put on a suit and pass through three rooms, three cases in each room, seven minutes for each case. Please, that just sounds like a fantastic way to spend my 63 minutes. Just loads of fun. Definitely well spent money. I don't think I've ever been more sarcastic in my entire life. To say I am dreading the orals, quite the understatement. The only thing I know is that I will study, I will prepare, and then I will pray. Oh Lord help me!

The following are a few backlog pictures from Indiana that I was able to sneak in after returning from Colorado and before starting at Franciscan. 

Running alongside the Wabash River is a trail. The Wabash Heritage Trail. It is a very nice trail, almost completely protected from the sun which is nice for a break on these summer runs.

The Wabash Heritage Trail as it crosses the Davis Ferry Bridge.

Was able to squeeze in a visit with two friends (Maggie and Whitney) that I haven't seen in years. It had been so long that I'd never gotten to meet those two littles of Maggie. It had been so long that when I reached out, I had to simply start with "I have no idea what your schedule is like these days..." because it was the truth. But so thankful was able to reconnect for a brief moment. 

I also joined a few friends at the Taste of Tippecanoe which was held in downtown Lafayette. Trying to experience Indiana as much as I can while I'm here.

 Taste of Tippecanoe, downtown Lafayette.

Much Love.