Estoy uno de un millon.

Mid-life crisis. I am going to take the idea and correlate it to a mid-residency crisis. I figure in a 5 year residency I'm technically in the 3rd year, theoretically the middle. No one has ever really mentioned a mid-residency crisis before, but I'm pretty sure it's a thing. Whether medicine, psychiatry, radiology, etc. etc. etc. There is a point when the resident has to transition from a "feed me" learning to a trial-and-error learning, based on their own decisions and actions.

Unfortunately, there is no outline to follow. No step-wise algorithm to guide ones steps.  It can be quite stressful for an individual to navigate. To take the examples they have seen thus far and really for the first time start to implement them. 

Am I having a rough patch? Perhaps. But really, who doesn't from time to time. It's only normal to feel like you need a break, a respite, some R&R. Even Jesus walked away from it all when he needed to. Only difficulty with that in this particular case, is I can't exactly take that break. Frustration, stress just stays pent-up and borders on anger at it's inability to be released.

We push on nonetheless. When we hear the medicine resident slam down the phone in its cradle across the trauma bay, heads pop up at the sudden sound, but settle right back down again. We've all been there. Or when the chief yells that someone has touched their coat, everyone carefully tip-toes until safe to resume normal speed again. They weren't really mad about their coat. 

We'll make it through. As so many have done before and many many more will do for years after us as well. I'm just a small one of a million, all the same, no different from my fellow co-residents. Neurosurgery, Pediatrics, Oncology alike approach that mid-residency crisis when faced with staying true to themselves yet realizing what it means to be a Neurosurgeon, a Pediatrician and an Oncologist when in the trenches and on the front lines.

Much Love.

Estoy enseñando.

As I am able to progress through residency, claim more experiences under the belt, my role as teacher has become a little less daunting. 

Over the past three or four years I've become a firm believer that the role of the student is to surpass the teacher.  The role of the teacher, to help their student(s) achieve just that. If it does not play out accordingly, shame on the student. And, shame on the teacher. 

I have it easy as a teacher in the fact that, for the most part, medical students want to be there. That being said, I respond in teaching to what the student brings. If they are willing to invest in the service of surgery, I will reciprocate with investment in them. And I will do so with as little propaganda as possible. For the most part, students are incredibly sensitive and vulnerable. They listen to everything, and take everything to heart. I soon realized that if a student is interested in pursuing another area of medicine there is only a minute amount of time to impact him or her before they go off into their desired area and forget all about surgery.  Only a minute amount of time to encourage them to be the best doctor EVER. 

I broke my own rule the other day. My rule about no propaganda. I do not want to tell any student to go into surgery. I believe they have to make their own decision. Because that day will come when they are exhausted, cranky and facing a 24 hour call and they will have to fall back on their initial decision. But the other day, a student approached me about her future. She is an excellent student, still not sure what she wants to do, and therefore interested in everything. Or that's what she says, but her every action screams surgery. I can see it, her fellow classmates can see it, and honestly, she knows it just won't admit it. She came to me almost as if she needed me to say it. And for the first time I told a student to choose surgery. Yes, keep an open mind, I told her. Yes, feel free to apply to any and all specialities you desire. But make sure that surgery is one of them. And she nodded. I hadn't told her anything she didn't know.

Much Love.

eu sou grato

I learned three phrases in Portuguese this past weekend.
hello = oi
yes = sim
no thank you = não obrigada
  
Can't say I actually used them all that much. There's only so far into a conversation you can go with not much more then hello.  Unless that conversation is with a baby... I found it quite humorous to hear a Brazilian say hello to a baby, "oioioioioioioi!" 

Wagner is one of my co-residents. He was actually a 1st year prelim with me two years ago, and now he's back at the hospital as a 2nd year prelim. He invited me to join him and his wife at his sister's house in Pennsylvania for a Brazilian BBQ just like they do back home. To be honest, I was still in bed when he called Saturday to let me know they were about ready to leave, and seriously considered staying there. But the idea of a really unique experience won out in the end and I was soon out the door.

 The BBQ started at 3pm. The first meat to go on were the short ribs. Above picture, spearing the short ribs. They were the first to go on, and then the last to come off, passing the evening slow cooking on the higher racks above the coals.

A cooler full of meat already lined up and ready for the BBQ.

 

So Much Meat. As one would finish it would come off the BBQ, be sliced and passed around on a plate. There were toothpicks available, but half the time just pick a piece up with your fingers and lick them clean afterwards. 

Meat wasn't the only thing served. There was also rice and feijoada (Brazilian black beans). But it was mainly the meat.

 

Chicken heart

They loved them and would gulp down two or three at a time. I was so lucky to grab one with the aorta still attached.  obrigada, mas não obrigada.

 

Each meat was cut right off from the skewer. This was the spicy sausage. The Mexican in me was so under impressed with their version of "spicy"

 

 This gentleman owns a Brazilian restaurant there in PA. He blessed us by cooking all of our meat for us; half of the night with his son hanging on his neck. :) They were from an area of Brazil with German ancestors, you can tell in the blonde hair of the next generation. :)

 This gentleman in pink is apparently super famous in Brazil. Everyone kept making sure I was aware of how famous he was. He was explained to me as kind of like Shania Twain famous. He used to sing Brazilian country music with his brother (Gian & Giovani), but they have since split up and he's currently touring in the states and joined forces with the gentleman on the right, Doug Sanders. Doug is a friend of the family, hence why they were there Saturday with their band. 

 

Pretty sure I was the only one there that night who did not stand up for a picture with Gian, but I could still appreciate the music. :)

Much Love.

Estoy regresando de un barbecue brazileno.

Something happened this past week. It was the result of one of those hard lessons from last Friday, reaffirming that even hard lessons can be good lessons. 

This particular lesson involves a case in the operating room. It was a difficult case, there was a lot of badness going on and we were doing our best to stay out of trouble. At one point, my Attending suggested one option that he wanted; to which I immediately responded in polite contradiction. For whatever reason, my Attending allowed me to win the decision and we finished the case. Come Monday our poor patient was not doing well. After work up we were able to determine the reason. My Attending came to me and in a backwards sort of way thanked me for that decision. It was the one thing that probably saved our patient from crashing over the weekend. And I realized for the first time, that I have learned something over the past two years. With the shear amount of surgery I have yet to learn and understand it's easy to forget that it's not impossible. 

One of factors of the above example that tells me I have learned something is the fact that I was able to say something. I'm not unaware of the fact that it takes me so much longer to learn something than my colleagues. I have to go over it again, and again. And if asked to give a response orally I still probably couldn't respond. So I have to go over it yet again and again. So, the fact that in the moment and under stress I was able to make a decision AND verbalize my opinion. For the first time ever I feel that maybe I have learned something. It's only one tiny little thing, but it holds such encouraging significance to me!

Much Love.

Estoy azul como el mar.

Easy to tell that the days are getting shorter. I raced the sunset home twice this past week. First time looked like God had painted using oil pastels and the second looked like a giant golden goose egg nestled among robin eggs. But that didn't matter as both times the sunset still won. And the remainder of the nights, sunset was long gone by the time I got to leave. To top off a busy couple of weeks, Friday was a day of hard lessons for me. It was a good day. Good due to the fact that I learned some good lessons, but... they were hard.

Thankfully I'm on call Saturday night this weekend, as the day was a bit difficult for me. I could tell that Friday had taken it out of me a bit more than usual. Just moving slowly. I sipped my coffee so slowly that it went cold before I could even finish it! Attempted to take care of some personal issues, and a trip to the bank got me outside. So nice outside. My neighbor, Charlie, was cleaning up his golf clubs for a day of usage and commented on how I finally had a day off! To which I responded that I was just on overnight instead of the day. He shook his head and told me to enjoy what I could of the day. I don't know my neighbors very well, just for lack of opportunity to get to know them. Yet on a day which I really wasn't feeling well his sympathizing shake of the head was rather comforting.  I took it as the hug that I needed. We all need someone to sympathize with us once in a while right? Shortly after that, I gave up trying to be productive. I pulled up my curtains and opened my door wide. I put myself back to bed pretending I was outside enjoying the day.

Much Love.

Estoy mi propio equipo.

A 5th year general surgery resident is considered a Chief resident. A title granted by the mere passage of time. And like all individuals, each Chief has their own unique personality, and with it, their own unique leadership styles. As you can imagine, some of those styles are good. Others, not so good. As a junior resident/intern we can take a lesson from each style. Put together what works for us and in a way determine what kind of chief we want to be one day.

My current chief has completely divided our patient list by Attending, and granted the care of one specific team to myself to carry. I don't mind. I've been asked much harder things before and survived. But then, our chief went on vacation. And it's no longer physically possible to cover my own list. Simple example, three of my Attendings are all operating at the same time. I am one person. And then say I borrow my second year to cover a room. 1+1 = 2. In no concrete mathematical equation nor even in any theoretical idea can we physically cover three rooms going at the same time. It makes for some late nights at the hospital as I retrace the entire day organizing the list figuring out new patients, post op patients, discharged patients and trying to fill in missed holes in each of their plans. So even if "my chief" has technically nothing to do with my list, it'll still be nice to have a little more coverage in the OR.

Although looking ahead to Monday, there's four rooms going at once.  Now... what to do about that?  I find myself somewhere between a pickle and a rock.

Much Love.

Estoy estable y segura.

There are two key words that I emphasis to all medical students that rotate with me.
Stable. Safe.
Is your patient stable and safe?
If not, what needs to happen to get them there?
The time when this is most important is discharge. Have you addressed all issues?  Reassured all concerns? Answered all questions?  Whether the patient is going to rehab or to home, with family or alone, is he/she stable and safe?

The other day I discharged a patient. An individual whom I have taken care of multiple times over the past couple of years. It has been a very long road for this family, and without saying it, they all...(the patient and the family)...they all knew that they were at the end. On both the Attending's and the family's request I spent hours and hours on this one discharge. Crossing every T and dotting every I. Spelling instructions out as carefully as possible. Handing what is natural to us in the hospital over to a family with nervous hands and breaking hearts. As I worked with the family to teach them the steps for connecting and changing the patient's tubes I couldn't let myself actually look at the patient. One look at his hungry gulps for air and everything in me would say... This is NOT a Stable and Safe discharge.

This is a talent I do not have. When our purpose is to help and to heal how can I let him go home to die?  I don't know how, but I did.

I hit another first this past week. For the first time ever, I introduced myself to a patient as Dr. Stoller. I needed a certain reaction from this patient. I read the situation, used the Dr., and got the desired reaction. I don't know how I feel about this. Was I too impatient to work with the patient otherwise? Was I abusing the position that God has placed me in? Or was I simply understanding what the patient needed and stepped out of my comfort zone to where she needed me to be for her?  Either way, it was a first.

Much Love.