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.

Estoy aprendiendo humildad.

A common phrase heard from the general population is "I can't". Spend your day eavesdropping at your favorite local people-watching site, and guaranteed you'll hear it more than once. It is used to mean many different things. Sort of a socially acceptable way of saying, "I am unable," "I don't want to," or even simply in place of "no." 

I personally do not like the phrase. And believe that if an individual honestly believes that "with God all things are possible," it should be a phrase that never escapes one's lips. Because with God, you can. And saying "I can't" puts up boundaries that God will respect and in so doing one is limiting what God is able to do in your life; a.k.a. what wonders He is able to work in your life. 

I knew this would be a difficult hurdle for me to tackle moving from a tertiary care center to a community hospital of much smaller scale and capability. As the tertiary care center of Westchester County in NY, approximately 66.67% of our patient population was transferred to us from the surrounding hospitals. There was one rule. We never said no.  We as residents would hit our 25th consult and exclaim something along the lines of "closed for business" or "shut down the ED, we're going on diversion." But we knew no one was listening and the 26th consult would beep over the pager, and the 27th, and so on and so forth. My top 24 hour call was 34 consults (this included traumas). 

So now I'm on the other side of that equation. I still want to say yes, and I'll go and see the patient. Swallowing my pride and saying, "this case would be best served with the expertise of a specialist" feels to me like I'm saying, "I can't."

Systems-based practice is one of the 6 core competencies defined by the ACGME. It's one of the harder concepts to describe and if you google it, some nice sounding explanations can be provided. But in short it is the ability to adjust to your environment and still maintain effectiveness.  I have before me a culture shock, and I need to learn this new system and adjust to my environment in order to be effective. And so though I'm struggling with it now, I will swallow my pride trusting in the will and provision of my Father that once my environment changes again in the future, and should I find myself back in a system in which "yes, I will manage that" is always the answer I will be able to adjust again and provide effective care as needed. 

As I have witnessed the group attempt to transfer a handful of cases the past couple of weeks to the regional tertiary care centers, I have been taken aback to hear a negatory response. Honestly, we weren't allowed to say no to a transfer in New York. I asked around, and the general response was of similar surprise. Usually a transfer is not so readily rejected. The cause of our current predicament in the state of Indiana.... none other than COVID. COVID numbers going up, hospitalizations going up, and ICUs being filled with COVID patients. My heart sinks to feel like COVID followed me from New York and I greatly miss being in a culture accepting of the vaccine. The worst part about it here is that it's not just that COVID patients are taking up beds. There are actually beds open. But the limiting factor is actually staffing, and finding individuals who are still willing to care for those patients. Honestly, here in Indiana numerous medical staff have retired or quit in the past year, and those that were attempting to hang on have been walking out mid-shift refusing to go through the process of caring for something that we have the means of making manageable. 

I saw a meme the other day that illustrates a bit of what this process is feeling like here.

On a much lighter note, I also saw this illustration and got quite a chuckle from it. #surgeonhumor

Much Love.

Estoy gritando a mi mismo.

The best word I can think of to describe this past week is not one that I was ever expecting to use, Gentle. 

This is my new team. The schedule they created for my first month gently eases me into our group's typical rotation of week call. In other words, True was on call this week, and I took call on Tuesday and Thursday to give him a little break during his week. I am not scheduled for week call for another few weeks. This gave me the extra time needed to figure out the new computer system, to get lost in between the hospital hallways enough to figure out were I can find my patients, and work out the kinks of things that come with starting a new job like my pager not receiving the trauma alerts, or how to call in the teams so I can do a case at 10pm. Kind of important. 

As True was rounding this week I spent a careful amount of time with him, in order to start making mental maps of the hospital, get my questions answered, and to start showing my face to those I'll be working with in the OR, the ED, on the floors, etc. This leads to the first lesson I learned this week. Whenever meeting new people, I'd introduce myself, who I was, who I was working with, etc. And inevitably, the response was along the lines of admiration and respect for my partners. The most significant came from one of the ED docs, who offered that the main reason he had decided to stay permanently at Franciscan was because this group of surgeons are so good. For a little background, the relationship between ED docs and surgeons is historically rough at best and tempestuous at worst. So hearing that meant more than what is carried by the mere definition. In conclusion, for someone in my position who is limited in time, to develop and establish myself as an independent surgeon, God has seen fit to place me in such a situation with maximum potential. The bar is high, very high, and should I put in the effort, we'll see what God can do with these hands next. 

The second lesson I learned this week was not as happy to learn. Don't get me wrong, it was humbling, and good to learn, just not happy. While rounding one day, prior to entering a patient's room, I leaned over to the PA and asked her if anyone would yell at me if I did xyz. She looked at me with alarm and responded, "No one is going to yell at you!" More than her response, but her alarm at my question, caused a lump to rise in my throat (which I quickly pushed down since we had now entered the patient's room) and allowed me to finally believe something that I had doubted ever since my interview back in October of 2020. Which is that surgeons can be supported by their partners, by their teams, and by their hospital staff. I had left my interview in October in absolute disbelief that such a thing could exist, and my now partners were all just trying to paint me a pretty picture, it wasn't actual truth. It's a whole new world! And yet.... I got home from call the other day with a well-known sinking feeling. No one had yelled at me. No one had been hurt. No one had even told me I had done anything wrong. I just knew I could have done a better job. And it forced me to admit to myself something I'd always known. It never did matter who was yelling, how loud they were yelling, or even what they were saying. The only voice I ever heard had always been the loudest and most severe anyways. It had been my own. 

Despite my imperfections, subpar decisions or slow decisions, my lack of confidence in treatment plan or diagnosis; despite whatever issue I'm yelling at myself for; I pray that God can mold me into a vessel worthy of whatever task He deems needed. Wherever He deems it needed. 

Much Love.

Estoy agredecida por las montañas.

 Hold up! Change of plan. I'm buying a Subaru and moving to Denver! ok, ok perhaps not actually happening and I may say that about any place I visit if you know me well enough. But seriously, if given the option, I would pick mountains 110% of the time. 

Jenna Wiegand, Amanda Virkler & I (nicknamed the Wolfpack by Jenna's sister) have been blessed to travel together over the past 5 years. After Jenna married, Amanda & I planned to continue our travels, which were put on hold by COVID. At the same time, Ethan & Jenna Hartter moved to Denver, CO from Hoboken, NJ last year as the pandemic pushed them both to work-from-home capacity in their respective careers. As a result, two years have subsequently elapsed since our last escapade, and it was high-time that was remedied. Due to job restraints, time restraints, and of course the virus, the logical solution was a reunion in Denver.

After collecting Amanda from the airport, Jenna & Ethan settled in for a full day's work, and Amanda & I went out exploring. We went to Red Rocks, on watching as the stage was being set up for the nights performance I set about looking for tickets that we could return and experience it... all sold out. 

We hiked the short paths surrounding the amphitheater at Red Rocks. 

We tracked down the Molly Brown house museum. But timed it poorly and were not able to enter.

So decided to sit on her front porch for a hot second instead.

Colorado capitol building.

Larimer Square.

I was very impressed to find these two set up in Larimer Square with signs saying, "pick a topic, get a poem" I couldn't resist, and gave her the topic of "Wolfpack". 

She did pretty good, no? 

Howl with me

And I know,

we sit solitary,

filling loneliness with

telephone wires

separated by God and cartographers.

But we're here now,

Under the light of the 

same moon glowing,

so howl with me,

know we're all screaming for each other's company.

and soon we'll

be a choir in perfect harmony.

~ Corvo

Our hike on Saturday was a comedy of wrong turns, but we were so bound and determined to get lost in the mountains, that we continued with the flow and ended up with an amazing hike from the Hessie Trailhead up to Lake Jasper.

Hike to Lake Jasper

Howl with me

It's tradition!

Iconic Wolfpack

Cracking up because we had just realized Ethan had been videotaping that whole time (see above two photos)

Talk about finding your inner peace...

Lake Jasper

Relaxing at Lake Jasper

Lunch break at Lake Jasper

Lake Jasper

We explored the shores of Lake Jasper a bit before heading back down the mountain.

Climb the Mountains.

Stopping in Boulder, CO for dinner on our way home.

After church in Denver we headed to Chatfield State Park for a stroll and a swim.

 

Granted our "swim" consisted of standing toe deep in water and chatting until the wind picked up and threatened a storm. 

The next day Amanda and I got to take the Subaru off-roading to a hike even further up the mountain. Hiked the 4th of July trail.

I am not one to typically focus on the flora of my surroundings, but the mountains were absolutely bursting with color. I don't have it represented well in any of the pictures I'm posting, because it does not come out well in these 2D representations.

So many streams and waterfalls along the way.

Arriving at Diamond Lake.

Diamond Lake.

Diamond Lake.

Amanda humored me with a bit of rock climbing and scrambling trying to get around the lake.

But hey, had to get to the other side! Diamond Lake.

Enjoying ice cream at Yum Yums. Delicious flavors such as Vincent Van Goat, and Absolute Thyme.

For our last morning, I had wondered out loud if we should perhaps need to be more chill.  Silly me. Not the wolfpack. Jenna moved some of her meetings around and we squeezed in one last hike prior to heading back to the airport.

Nice hike up Belcher Hill.

Thankful for our time together, the trip, and the mountains. Sufficiently distracted myself. Now back to reality. 

Much Love and Prayer.