Estoy preparando por la próxima semana.

Already a week into Block 3 of the year. It’s going by even faster than I could have imagined! I had a brand new team start this past week. I was a touch more apprehensive than previous blocks as I had never worked with any of my team members before, and therefore wasn’t sure if I would need to alter my approach at all. Turns out, on Vascular, there’s no time to worry about your approach anyways. But for the most part they all kept up, even caught on quicker than last block. Maybe members from last block gave the incoming residents helpful pointers? Probably, but eitherway, I hadn’t needed to have worried.

As nice as it is to be busy and operating every day, I’d be lying if I said keeping up with the active schedules of all 6 of our Vascular attendings wasn’t exhausting. In the first 8 weeks (2 blocks) there was a grand total of one day, I had been able to spend some extra time with my team. And that one day, happened only because one of our attendings was on vacation that week and it was usually his operative day. It happened for the second time this past Friday! Again, because one of our attendings was on vacation and its usually his operative day. My rounds in the morning, took probably twice as long as they usually do, as I spent time with the medical students going over presentations.  I had warned them the day before to be ready, and they did a fine job. I’d wait till they finished, racking up the corrections in my head as they presented, then go back over them one by one. I was nice… at least I think I was. Told them they were doing a fantastic job, etc. Yet, for one student you could see the beads of sweat multiplying on his brow as he shuffled back and forth before me trying to get through his presentation. I should make more of an effort to have the students present more often, with practice it’ll become easier for them.

I still got to operate that day. It wasn’t Vascular, but I helped cover a case for the Thoracic team. And then, I had plans to spend time studying. But to my happy surprise, each time I walked into our chief call room, I’d find my co-chiefs Ansab and Ash, chilling and talking. So of course I had to join them. This had never happened before! Our paths cross, yes, but usually it’s while one of us is either running in or running out of the call room and consists of a Hi and Bye! So, by the end of the day, I hadn’t studied at all, but we had discussed schedules, interns, attendings, futures, struggles and methods of chiefing, and I had even gotten lunch! We all concluded that it was a very weird day, but welcome. We wouldn’t change it.

All of my Attendings are back again this week, so planning for a very full and busy week once again.

Much love and prayers.

Estoy disfrutando el verano.

Ever since moving away from Central Illinois and becoming separated geographically from everything and everyone I'd ever known, social media has been an important avenue of information for me. Partly my own fault, I make minimal effort to maintain open active communication on a regular basis. Communication not a forte of mine, believe I've mentioned that before. And partly, that's just how life happens. Out of sight. Out of mind. When someone moves away, they exit and enter spheres. These spheres I'm referring to, being the small bubbles that each individual human being walks around in, contain an entire universe individually personalized for their specific human being. Some spheres are smaller, some larger, but we all have them. Just meet someone new, watch your own sphere expand. 

Anyways, social media has helped me stay updated as my friends have grown their own spheres. It's nice to not be completely out of date when I am able to make it home for visits, or am struck by inspiration and initiate a string of texts, etc. Over the years, this same avenue of information, has provided its own fertile ground for seeds of discontent from time to time. Was much harder to stop the growth and weed immediately 10 years ago than it is today, but I'll still catch it from time to time. Summertime is one particular season that I've grown to dislike less and less over the recent years. Watching through pictures and posts as one by one friends and families get together and enjoy each other and being outside, while I am not. But inevitably comfort is always provided. For example, a few brave souls agreed to meet me for a picnic at the beach the other day. 

Due to my own stupid carelessness, I'd had recent contact with COVID positive patients without wearing the appropriate PPE. Since that time, I'd caught myself and corrected my actions of course. I confessed, and they still agreed to dare come within 6ft of me!! (Don't worry, less than 6ft and we had our masks on!) So I got to have my own summer vacation with family and friends!  It only lasted an afternoon. But it was sunny, and warm, and relaxing!

Silver Sands State Park. CT. with Emily & Kate Walder and Cheryl Ryan

Silver Sands State Park. CT. with Emily & Kate Walder and Kevin Ryan

Silver Sands State Park. CT

 

Silver Sands State Park. CT

 

Happy Summer feelings!

Much love and prayers!

Estoy ayudando a mis profesores.

 I've noticed my Attendings pushing me on the oxymoron that is the practice of medicine. They ask me, "Are you sure?" The truth... there is never anything 100% in medicine. I've seen it time and time again, there is no guarantee. I know it. They know it. They know that I know it, and I know, that they know, that I know it. So really, it's a test. After glancing at a chest xray for 5seconds, was that enough time for me to weigh the risk that I missed something, and despite that, make a decision about patient management. Yes. The answer is yes. In my opinion, indecisiveness and/or fear to make a decision due to the plethora of reasons readily available in medicine, is often the more dangerous option. For everyone involved, from the patient, to the nurse, to the family member. So practicing what I preach, when the patient, filled with bullet holes, looks at me en route to the operating room, and asks if he is going to die. I say no. No sir, not on my watch. We got you! You're going to be just fine. I don't just say it once, I say it multiple times, in many different ways. The patient needs to be on board with this plan, and if my decisiveness will help him feel that then, Yes, I am sure!

I recognize, that as a resident it is still exponentially easier for me to have this opinion, then when I will move into the position of attending and become ultimately responsible for such decisions. Hence, why I make a point to exercise my decision making practices as much as possible now before entering into that different tier of responsibility. 

On the otherhand, I also recognize that as a resident, I am allowed a certain level of leeway on my knowledge, and from time to time am still allowed to say, "I don't know." I used that unspoken margin of freedom the other day. Was working with my attending through an angiogram, and we quickly identified our patient's problem. Looking at the details of our patient's blockage, my attending made a decision based on a potential complication that he could see happening should we be successful at clearing this particular blockage. To prevent such a complication required the use of a very specific catheter, one which I have never used before myself.  I watched, rather uselessly, as my attending attempted to assemble the catheter. Unsuccessful in his attempts, I could see the gears spinning through the options in his mind. Should we just proceed without the specific catheter, it is just a possible complication afterall. No guarantee it will happen. I finally played the resident card, leaning in so only my attending could hear me (the patient was awake for the procedure), I asked if he'd like me to break scrub and youtube a video. He thought a second longer, pausing, before dropping his head and nodding. Sure enough, there is an excellent instruction video on youtube, through which we were able to identify our mistake in the catheter assembly. The procedure went by successfully, and sure enough, my attending had been right. That special catheter prevented a potentially devastating complication from happening. My attending, heartily thanked me for looking up the youtube video, his relief almost causing him to be emotional.

At the end of the day, medicine keeps me learning, keeps me humble. It is the great equalizer. Even while answering, Yes, I am sure, a part of me judges myself for such a lie. 

Much Love and Prayers.

Estoy peleando una batalla ya perdida.

 What is Vascular surgery? Easy answer is surgery on the blood vessels, the arteries and veins of the body. A seemingly invisible roadmap that runs throughout our bodies, avenues, highways and byways that allow blood, carrying oxygen, from our tiptoes to our nose. And in so doing, allows life to persistent, for as I explain to so many patients, oxygen means life, without blood there is no oxygen, so without blood there is no life. A Vascular Surgeon's job is to ensure that blood continues to perfuse all the way from those tiptoes to that nose and everywhere in between. When our own roadmap gets potholes, downed telephone wires or perhaps herds of sheep clogging the way, blood flow becomes disrupted, tissues downstream become starved of oxygen and start to die. The Vascular surgeon must fix the potholes, move the telephone poles or find and/or create a way around, and get the sheep off the road before the ischemia down-stream becomes irreversible. 

It can be incredibly rewarding to finish a case, do a pulse check and find a fat bounding pulse where there wasn't one before. It can be incredibly elegant, cleaning an artery and then patching it back together, the finest suture placed technically perfectly. It can also be defeating, mentally, emotionally and physically. 

There's a joke that a vascular surgeon really only needs a few patients to stay in business. And that's a funny joke, because it's so true. These patient's that I've been seeing over the past weeks have known my attendings for 20+ years. So many of their faces I recognize from my own past experiences on the vascular service, only last time they had more of their toes, or they still had both limbs back then, etc. 

The other week we had a new patient, not your typical vascular patient (elderly individual with multiple co-morbidities). In fact the opposite, young and relatively healthy except for her odd history of strokes and blood disorder causing hypercoagulability. She had gone to other hospitals complaining that her toe hurt multiple times and been sent home each time. By the time she got to us, not much blood was making it to her foot anymore. Over the course of two days, I spent a total of 15 hours (8hrs + 7hrs) in the OR working on her leg. We got it to her foot at one point, but it didn't last. Kept trying old tricks and new techniques, I actually learned a lot in the process, but nothing could get the blood down to her foot. Flow stopped at her ankle. At the end of those 15 hours, I sat exhausted with my attending, both of us trying to smile but it coming out more as a sad pathetic chuckle. Tough defeat to swallow. We didn't do the amputation until almost a week later. The delay wasn't a patient factor, she was mentally prepared and ready sooner than we were. It was surgeon factor.

That's the thing with Vascular surgery. It is fighting a loosing war. There may be intermittent successes, but the question is always, how long. How long will it last? Because it will eventually fail. Despite maybe two or three or even four battles fought and won, there will always come the final battle where all will be lost. 

 

Much love and prayer!

Estoy capitán de W.O.W.

W.O.W. was started my first year of residency as a prelim intern, by the female chiefs that year Irlna and Alison, 50% of our program was female that year. Women Of Westchester was designed as a support for female surgical residents and has remained in place since that first year. In the seven years since its initiation, not all years have been as successful as others, mainly due to the female chiefs of any given year. Some were more invested, and others not so much.

I see the benefit of a group like W.O.W. and have advocated for its continuance especially during those dry years when there were no female hires and female chiefs more interested in... other things.... than creating an environment of support and camaraderie.

Now W.O.W. falls into my lap, and I quickly realized that supporting W.O.W. and encouraging others to plan events is so much easier than doing the actual planning myself.

Living in a dirty study apartment where there is no more than a pair of folding chairs to sit on and every inch of table/counter space is buried under stacks of papers, articles and books filled my head with a plethora of reasons of how I could not possibly host a W.O.W. event myself.

So I had to first get over those excuses, warn everyone that we would be sitting on the floor, and then do a more thorough job of cleaning than, well, I don't really want to know since when.

Unfortunately, the day of, in the middle of scrubbing my apartment, I got a message that one of our ladies had been asked last minute to cover at the hospital. Despite trying to find an alternative option, we were unable to do so, meaning that we could not all be together. But 7 out of 8 is pretty good at least. We all sat on the floor and played games, ate food, and made plans for the year. Successful first W.O.W. meeting of the year!

Our brand-new categorical interns L to R: Thanh, Nicole and Kira

PGY2s: Alex and Sara

Sara demonstrating how to play The Mind. (A group card game where you can't talk to each other)

W.O.W. '20-'21

We were missing Ida, and took our group photo after Clara had already left. We'll have to commit to better planning of the photo taking next time.

L to R: Me, Nicole, Alex, Thanh, Kira and Sara

Much Love and prayers.

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.