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.