Estoy una comunicadora excelente.

Block one of the year is already over. We had a small team on Vascular, and we managed, but I think we all felt the strain from carrying extra work. I started out the year with one of the busiest services, but I guess prefer that than finishing with the busiest.

I've been the senior most resident on my service for the past year, and in that position, the acting chief resident of the service. So I was therefore not expecting this year to be so different. But there is an expectation, a responsibility, and in some cases a stereotype that comes along with the position of chief resident. And trying to live up to that expectation, fulfill that responsibility and if possible break the stereotype that if I'm honest, really has me struggling at times. If I were to give myself a grade on my "chiefing" thus far, it'd be a nice fat F for failure. I've got so much work to do the next 12 blocks.

One of my biggest failures is communication. I'm not a fan of unnecessary and/or futile communication, it's inefficient and waste of time, in my opinion. But I remember chief residents getting so angry with me as an intern when I would unintentionally leave them out of the loop on an event. It was always unintentional, but I would simply be taking care of a situation, perhaps communicating directly with the attending, or someone else involved, and forget to let any third, or forth or fifth parties know what was transpiring. I guess all their yelling really didn't impact me, because I still have found myself in similar situations, only difference is now its the Attendings getting angry with me rather than a chief resident. It's easier with our teams now because we have group chats that all updates and issues get sent to, so every resident on the service remains updated at all times. Not such a acceptable idea with Attendings, so if something happens I have to text/call/message not one but multiple, all who may be interested. And when I'm in a post call exhaustion, trying to keep it together to get plans for my team to carry out for the day, all while not missing a fever, or a drop in hematocrit, or forgetting a pulse exam, or antibiotic, or anticoagulation regimen.... superfluous communication is the last thing on my priority list. Maybe by confessing, I'm hoping that I'll be able to remember next time, and do better at my communication.

I also realized towards the end of this block that my poor communication is negatively affecting my interns as well. On Vascular, as I mentioned, it is super busy. In order to give my team as much time to get ready in the morning I request to meet with them at 06:30am, but in meeting at such a time it means we really have to fly through our rounds. It is not uncommon to see a vascular team member running down the hall or up/down the stairwell to catch up with the team as he or she was left at the last patient to finish the dressing change. Once again, I prefer to cut out superfluous communication in order to speed things up, and therefore let the patient know the plan for the day and then check over my shoulder to make sure the team understood the plan as well as we take a quick sprint to our next patient. I don't stop to make sure our intern understands what went into the decision making part of that plan. I realized I wasn't even asking my intern to analyze our patient's vital signs. I was doing it myself in order to speed things up on rounds. I caught what I was doing and tried to remedy it towards the end of the block, but was probably too little too late.

Going to be making a few changes approaching the upcoming block, starting tomorrow bright and early. If I can make small improvements here and there, perhaps I can pull my F up to a D... D- at least?!

Much Love and prayer!

Estoy sola.

We asked for busy. Signed up for it in a way. I'm starting to realize I may not be taking care to get enough sleep to maintain our current kind of busy. I usually rely on caffeine, but its been so busy that I don't have time to get coffee throughout the day, so have to keep going on adrenaline and take care not to ever sit down. I'd not be able to get up again if I did. May have to do some rearranging of priorities... easier said than done.

Medical students were allowed back in the hospital. Hadn't realized it until I saw the short white coats wandering the hallways, but it had been months since last seen. We don't let them go to see any COVID patients and they aren't allowed to scrub on any COVID + cases, so keeping their exposure limited.

We haven't had our increase of cases in Westchester yet. Still pending. For now COVID has become more of a check-box. Any admission, were they swabbed? Any cases, what's their result? And on vascular we have many chronic patients, we list their COVID status on our list, making sure to repeat the swab weekly so as to always have an updated result in case they need an emergent procedure at any time.

The other day I had come in to round with my team and do a quick case. Our patient, COVID +, ended up becoming acutely unstable middle of the procedure, at which time we immediately aborted, and wrapped things up to go to the ICU. It was almost 90 minutes later when we were finally allowed to leave to operating room. I had spoken to the ICU myself, and we were set to go to PACU. I don't need to go through the details, but in summary, due to the patient being COVID positive, everyone wanted to make sure appropriate precautions were in place, dragging their feet, and then changing the plans on us multiple times. I grew rather frustrated with the system, sitting for 90 minutes with a critical patient. What was supposed to be a short case, turned out to be more a waste of time, unfortunately, which didn't improve my frustration in anyway.

But if that is our current stresses dealing with COVID, it pales with what many states are dealing with.  Have you checked the most recent curve? It's available and frequently updated.

It's unreal what is happening in our nation. This virus continues to wipe us out, irrespective of our age, race, gender, etc. People are dying, and many more are going to die. In a way we are acting like school-age children. I remember being still small and my entire universe revolved around me, my needs, my wants, my thoughts, wishes and questions. I had gotten frustrated waiting 90 minutes with my patient. How quickly I forgot what it was like to have our ICUs overflowing, and the hospital buckling under the burden of COVID. Reality in Texas, Arizona, Florida right now... and as those numbers continue to sky-rocket many more. Perhaps even here in New York again.

May we continue to pray for our fellow humans. Those sick, those caring for the sick and for those trying to protect one another.

Much love and prayers.

Estoy tratando de estar lista.

I feel like I'm settling. Not in a way of accepting less... nothing like that kind of settling. It's more a giving up of the resistance I've had to be a "chief," and a giving in and acceptance of being out of my comfort zone. After all, it is out of our comfort zones where we can grow the most, and learn the most. Where Jesus can meet us and call us up even further. I never would have signed up to be a chief; I don't want to be chief. But it's part of the process, and it's here whether I want it or not. I'm finally settled and ready to try, to do my best. Let's see what is in store for me to learn!! A whole bunch, I can only imagine!

My batch mates and I have made the transition to 100% chief call. As we were so starved for chief call last year we've collectively decided to take q4 call for the first few months of the year and then slowly transition, taking less call as the year progresses. It means we'll be working extra hard for the next couple of months... but that's nothing new. With us taking so much call the remaining years are very happy with the call schedules we have released, as it's much lighter than what they are accustomed.

As for taking chief call... it's a blast. I can literally operate all night and finally let my team deal with the... let's just call it lack of common sense, that drips from the consults we receive at times. Yesterday I went to the OR at approximately 2-3pm with one of my level 1 traumas that had just come in, by the time we finished and I got my patient to the recovery unit my attending was calling that GYN was in over their heads in the OR and calling for an intraoperative consult. We went in and took over. By the time we finished there one of my team members came to transport my patient for me as a transplant was on the table and about to start. By the time I finally got to leave the OR it was after 3am. I knew that it was a busy call for the team, but my job was to operate and let the ED senior handle the management of the business. For example, it was the ED senior that came to the OR to transport my patient so that I could cover the transplant case. He was managing the cases, the traumas, the ED consults and he needed me to cover the transplant, and I was happy to oblige. I started taking ED senior call as a PGY2, and after 3 years in that role I am so happy to not be there any more. And barring a second wave of COVID19 coming and wiping us all out, I don't plan to ever stand in that role again!

Much love and prayers.

Estoy la jefe.

Officially Chief.

Not that I did anything special to be called Chief Resident, in general surgery the PGY5s are all automatically considered the "chief residents". But it is significant. It signifies I'm almost there, almost to the end, almost done with residency. One. More. Year!

This past Friday was graduation for the chief class, half of them didn't even come into the hospital that day. And of the other half, only one of them actually operated. But as they moved out of the chief call room. I moved in. I was more ready to get out of the crowded senior call room, than ready to move into the chief call room. But whatever the motivation, I was happy to be there. I picked a shelf and set my loopes down claiming it as mine. As our incoming interns are in the process of going through virtual orientation, our chief class made a virtual appearance.  There's more than usual interns coming in for this year, so we've got our work cut out for us.

Our chief's graduation was virtual as well. Of all years I'm glad that I'm PGY4 as I got an invite to all of their small graduation gatherings. All 6 chiefs had their own graduation party and attended the virtual party collectively.

 

I had put together the "chief roast". Granted not really a roast at all. I couldn't pull off a roast if I tried, let alone try to do it virtually. So I made a video including clips from every one in our program. They seemed to enjoy it, everyone laughed. And they were all happy. They deserve to be happy.

 L to R: Hanjoo, Alex, Monica, Adi, Joe (Michelle was late again)

 

You can't read it in the picture, but the cake says "We survived!"  So true. What a reason to celebrate!
Hanjoo: Colorectal Fellowship in Dallas, TX
Alex: Robotic Minimally Invasive Surgery Fellowship outside of Boston, MA
Monica: Minimally Invasive Surgery Fellowship here at Westchester
Joe: Pediatric Critical Care followed by Pediatric Surgery Fellowship
Michelle: Surgical Critical Care Fellowship here at Westchester
Adi: Vascular Surgery Fellowship in Cincinnati, OH.

I'm going to miss them next year.
Much Love and Prayers.

Estoy trabajando mucho.

Had my own mass causality yesterday.

It started out by simply being a Monday. That right there is a bad day on the trauma service as inevitably the hospital has filled up over the weekend and needs major decompression. As if the conveyor belt stalls each weekend and everything gets backed up. So Monday was a bad start. Then it was a busy trauma day on top of that. We were already up to four traumas when an ED nurse runs up to me. There was a 15 passenger van in an accident. Multiple casualties. Multiple nonresponsive. Varying ages. And that's all they know at the moment. Thankfully I had a midlevel with me that day to handle the work, but this was bigger than us two. I sent out a message to my fellow co-residents asking for extra hands, and I messaged my Attending letting him know he needed to show up, and just in case he wasn't fast enough I called one of our critical care fellows. Organized as best I could with the little warning we had, and then the first level one rolled through the doors. I received that one and my attention was then focused to the task in front of me, broken only by each new trauma alert as it was paged out. With each alert an old familiar panic rising from my inability to be in multiple places as once started dancing in the back of my head. But slowly, and one by one a handful of co-residents started showing up able and willing to do anything. My Attending (he did finally show up) encouraged me to start managing everyone rather than running any one trauma. I think back on my co-residents showing up and all working together. It was absolutely chaotic, and at the same time so smooth. Multiple patient's went to the OR, lined up one after the other (trauma, orthopedics, neurosurgery, even OB). I took one of my patient's myself. By the time the mass casuality was handled, all patient's dispo'd, consults called, clearances granted or not granted and I had finally finished with my case it was 4 am.  I remember walking home through the parking lot in a surreal state; That I was going home to sleep knowing full well that my alarm is set for less than 60 minutes later. I did it though, showered, took out my contacts, and snuggled under my covers. All to turn off my brain and finally end the day.

It kind of worked. Being able to wake up and start anew. Relied on caffeine for the rest. I think back on craziness and get choked up with gratitude at my awesome co-residents. At morning report, the other attendings listened to each trauma being presented, eyes getting wider with each one. "Why?" they asked. "Why wasn't a Code Triage called?" I didn't have an answer per se to that question, but I could say my co-residents, they had it handled!

Much love and prayers!

Estoy contando los días.

The burden of COVID19 reached a new low this past week at Westchester. The remaining two COVID units staffed by surgical staff were disbanded, the remaining patients consolidated in other units, which in turn freed up the few surgical residents that had been assigned COVID. Those residents were reassigned to various surgical services after discussion amongst ourselves and then appropriate teams were notified of the upcoming resident coverage changes.

One of the current chiefs, unhappy with how the reassignments had affected him and his team, called me angrily demanding to know who had made the decision. Just one example of the many angry conversations I've been having over the past few weeks. Although one could say I'm used to being yelled at; doesn't make it any more enjoyable. I own up to the fact that, in general, I have a serious personality, but defend it by offering that I at least can still appreciate a joke and love to laugh and smile. I think I've smiled twice in the past two weeks, and both times it was forced. If not the truth, it honestly at least feels that way. Between managing the trauma attendings, and attempting to transition our program into a new year I'm not having a whole lot of fun currently. At the same time, and on a more positive perspective... I'm definitely praying exponentially more. It's more of a pleading. Begging for an increase in my ability to love. It's gotten me through many a conversation. Thankful I can forever rely on an unending supply!

Back on a COVID note, our hospital has now settled into a semi-normal setting. The halls are busy again, as all nonessential workers are starting to return to their offices. How the virus is affecting my patients specifically is the fact that every patient that presents to the hospital is automatically on precautions as a "rule out COVID" until their swab results come back. Imagine it, you just fell off a ladder, or wrecked your motorcycle, or jumped off a bridge. You've been wrapped up and whisked off to the hospital where you're intercepted by a swarm of blue-gowned, masked and shielded aliens. Before you can blink you're clothes have been cut off, catheters inserted into veins and everything that hurts poked and prodded... but wait that's not all. To top if off, swab goes up the nose until your brain is tickled. Just in case you weren't hurting before, you do now!

It's necessary, almost daily I have trauma patients whose swabs come back positive. Asymptomatic from a COVID perspective they still get sent to the COVID units, unsafe to be mixed with non-COVID patients.

Much Love and Prayers!

Estoy quemando velas.

Reality right now:

Out of bed by the third alarm, take my coffee with me and into the hospital extra early in order to get a handle on the damage done to the trauma list overnight before the day starts. Grabbing a free computer in the TICU, take my mask off to swallow some coffee, and then wait the 5 minutes it takes to log onto the system. Feeling like it's been a long week on trauma thus far, then proceed to sink into my seat realizing that... it's only Tuesday morning.  Realization shrugged off, face the day head on, corral the team, mobilize the patients, navigate the Attending's moods and address all new traumas including injuries and disposition.

All in all, each day got better, and we finally caught up with my Tuesday morning attitude and made it to the end of our first week. I even had time on Friday for administrative duties involved with transitioning to chief residents July 1st.

As the rest of the world grapples with social distanced celebrations and graduations, so is our program. All celebratory events cancelled, a few are trying to now find alternatives. The vascular surgery party hosted by Dr. Babu was moved to the backyard of Dr. Goyal and invites limited to the current chiefs and PGY4s. As these individuals have been by my side, all of us breathing the same stale hospital air filtered through our masks over the past few months, we had no qualms about taking class pictures. We overstayed the party time as stated on the invitation preferring to just sit by the pool (some swimming) enjoying the sun, and fresh air, and each other in a non-hospital setting. It was wonderful!

 Me, Monica, Alex

 The chiefs with Vascular Attendings: sitting Dr. Babu and Dr. Shah; standing L to R: Dr. Mateo, Dr. Laskowski, Hanjoo, Adi, Monica, Alex, Joe, Dr. Goyal (not pictured Michelle and Dr. Carroll)

 Dr. Babu and Alex

 Dr. Goyal

Hanjoo, Adi, Monica, Alex, Joe (not pictured: Michelle)

I worked with half of this group since they were interns, and the other half even longer than that. Many, many memories. Wish them all the absolute best on their future endeavors! Will miss them next year.

Much love and prayers.