Estoy dejando lo en paz.

Taking the ABSITE tomorrow, and very much looking forward to it being over for another year. I just need to think about something else for a change. Have a long list of 'To Do' that have been patiently waiting for many months now.

I'm not ready for tomorrow. There are those surgeons out there who like to remind us that you they do know everything, and it is possible to be ready to take the ABSITE/take your boards/or whichever test is before you. Unfortunately I am not one of those. Figured that out long ago. And so when I have long days, or non-stop calls, my study time gets chipped away little by little and I end up in my current predicament. Not ready to be tested on the vast field of General Surgery including but not limited to Trauma, Vascular, Foregut, Colorectal, Critical Care, Hepatobiliary, Cardio-Thoracic, Endocrine, Breast, Transplant, Pediatric, Pharmacology, Wounds, and then because we adhere to our title of "General" there's also a splash of Neurosurgery, Orthopedics, Gynecology, Urology, Plastics, Oncology, Infectious Disease and Anesthesia thrown in there. I'm sitting here attempting to go through practice questions yet at the possibility that it could help me get one more question right, but I'm about ready to give it up an go to bed. I'm post call, and got home late as half of us residents were taking the test today the other half of us needed to cover until they could get out of their test. And in all honesty, getting enough sleep might do more to help me answer that one more question correctly than going over a few more practice questions.

Time to let it go for another year.  Start working on being a better surgeon again on Monday.

Couple of pictures from about a week ago. The hospital mandated its employees to stay due to threat of a huge storm. I was so lucky to be on call. Of course wasn't affected by the mandate as we never leave the hospital anyways. But our lab down in the basement of the hospital was taken over by facilities to provide places for mandated employees to sleep. We had a little too much fun enjoying the air mattresses prior to morning report the following morning!

 Luis and James

Monica voted for morning report as is!  Ha, didn't last as she was headed for the OR not even 5 minutes after this picture was taken.

Much Love.

Estoy estresada.

Stress levels running a bit more piqued than usual at the hospital. The regular underlying daily stress that comes with the job. Drowning in the looming ABSITE exam coming up in a week. All stirred up with the threat that our program could be closing.

Program site visit was today. Representative of the ACGME came and interviewed us all. This was brought on by anonymous poor resident driven surveys and reviews completed about a year ago. I had a very hard time being stressed by the knowledge of this site visit. Worse case scenario, and our program was closed, well we'd figure it out if it came to that. But in the meantime, I've got surgery to learn. On the other hand, the administration spent the last few months scrambling to achieve strict adherence to all ACGME rules and make sure that we (us residents) were all happy and well practiced in how to appropriately respond to all possible questions we could be asked. I could not hide how little effort I lent the cause. They even had a mock site visit a couple weeks ago. I ended up being late, because I was finishing up a case in the OR. My program director actually came into the OR and escorted me out to get me to go to the mock-site visit. Later that day as I was scrubbing on a gallbladder with him he asked me if I thought the mock-site visit had been helpful. I shot him a look from across our patient, and he shook his head, "I know, I know, you don't like these things."  I will say, I at least, mustered the respect today to wear my white coat. They sent us a dress code for the meeting, business casual and/or white coat. My new white coat that the program bought for us. My name embroidered on it and all. Never before been worn, I wore it today. As little care as I say that I have for the cause... I really don't want them to shut us down.

As part of our ABSITE crunch time a few of the attendings have been volunteering their time to have extra study sessions with us in the late evenings. We've been calling it ABSITE boot camp.
This evening one of our vascular attendings went over questions/topics in vascular surgery.

 

Just in case you couldn't see him in the first picture...

He spent the entire 90 minutes stretched out on two chairs as pictured above. It's the crazy little idiosyncrasies of our Attendings like these that get imitated by residents when they are long past exhausted, and hungry and borderline delirious.  They resort to laughter to prevent the alternative. They use laughter to connect and relate and remind each other that we are in this together, that there is a bigger picture and we are still worthwhile.

Now back to studying.
Much Love.

I've been alternating my background study music a lot. Trying to aid my efforts to stay up even later and get up even earlier to study more.  It's helped... kind of. But I did like this cover, thought I'd share just for fun. 

Estoy recuperando.

I received many well-wishing texts and messages on 1/1/2019, I think I responded to some of them. I’m sure not all, honestly, I don’t remember what I responded to or not that day. But I will remember that call. Always. Monica had been the chief, and as we left the hospital the next day, she asked me if I wanted to go for pancakes. I knew she was just as exhausted as I was, but I appreciated what she was offering. Yes, we always want pancakes, but she was also trying to be supportive, make sure that I was okay. But sleep was needed more and so we parted ways.

When I woke up from my post call collapse, hunger was knocking hard. I realized that except for the random sweets I would grab when running through the ED or passing by the ICU, the only food I’d had in a while was a side salad and a few bites of gyro. I managed to stay awake long enough to eat and then go to the hospital for a review study session. Making it home again to crawl under my covers and disappear.  I finally woke up this morning having slept more in one night than is typical in three.

As planned I had gone into work almost an hour earlier than usual January 1st. Depending on how you want to argue it, that extra hour was extremely beneficial or completely futile, due to the fact that everyone else seemed to start equally just as early.

The OR was a supposed to be closed for the holiday, yet we had three ORs operating for the vast majority of the day and at least one going on into the night. With a five person call team, I had to send three members of our team to cover cases. Leaving the rest of the hospital incredibly impatient at the fact that I couldn’t split myself into three people to make up for their absences. Including my Vascular Attending who mentioned more than once, “you seem distracted, are you paying attention?” As I would steal a look at my cell phone in an effort to prioritize the nonstop onslaught of messages demanding responses; new consults, cases rolling back into the OR, requests for emergent dialysis access.

Yes, yes I was distracted.

At one point late in the day, I commented on how my feet were starting to hurt. Shortly after that I was pushed up to the OR and my Attending yelled out running after our speeding stretcher, “well, you said your feet were hurting!” Ha. Not exactly what had been going through my head. It was one of our level one traumas trying desperately to exsanguinate on us! I had jumped on top of him, jabbing pressure onto his bleeding vessels, not about to let up until we rolled into the OR and I finally had to so surgery could happen. That one made it!

I’m thankful for the team I had working with me that call. All of the cases were covered. All the consults were seen as quickly as possible. All the traumas were handled and prioritized. All the lines requested were put in. This is because everyone willingly worked together, everyone from my chief to my junior and both of my interns. When a request, a job or responsibility was given out it was immediately attended to by the respective resident. I’m very thankful for the responsiveness of the call team that day.

Much Love.

Estoy trabajando.

Every morning I enter his room. He somehow was lucky enough to have the corner room, stuck back far down the hallway from the nurse's station. If any place on a hospital floor could be considered "quiet", that just might be the closest thing. And that's where he has been, day-in and day-out. The living epitome of "convalesence", in the slow and disheartening sense of the word.
I wake him up. He cracks an eyelid, confirming what he already knows. It's just me. And he sticks his tongue out at me. His santa hat had fallen off at some point during the night. I ask him if I can put it back on. Without saying anything, he holds his head forward for me to replace his night cap. I ask him if I can check his wound.  He doesn't say yes, he says... "why don't you check my wound." And so it goes, every morning. And I wouldn't have it any other way. Anything less, and I would worry. He already has me worried enough. He doesn't want to eat. I've given him more than one lecture about the importance of his nutrition, the whole while he just quietly stares at me like a defiant two-year-old. Not about to verbally defy his doctor, but when his dinner tray comes, he then throws his supplement shakes on the floor. What more can one do?

Tonight is New Year's Eve. The end of another year, and as I look back on 2018... I'm tired. I'm sure this is impacted by my last month as acting chief resident of the Vascular team. Where everyday anyone of your patient's could code and try to die on you. Sometimes, for no good reason at all, speaking from experience. And therefore, you stay as sharp as possible looking for anything out of the ordinary. Is his heart rate faster today?  Is his magnesium too low today?  Did he not stick out his tongue at me today?  Every little thing matters.

I wish I could make him better. I wish I could get him to eat. I wish I could help them all. In the meantime, I'll keep trying nonetheless.

It's not about being tired, exhausted even. It's not about me. It's about being right here, where I'm supposed to be, and allowing God to build me into the vessel for which he has a use. I will get up extra early tomorrow. Prepare extra for my call. And hold my breath while I wake him up, waiting for him to crack his eyelid and stick out his tongue.

I wish everyone warm feelings and congratulations for passing another year of our Lord.  May prosperity, happiness and health be yours in 2019. God Bless!

Much Love.


I will lift up mine eyes unto the hills, from whence cometh my help.  My help cometh from the Lord, which made heaven and earth. He will not suffer thy foot to be moved: he that keepeth thee will not slumber. The Lord is thy keeper: the Lord is thy shade upon thy right hand.  The sun shall not smite thee by day, nor the moon by night.  The L:ord shall preserve thee from all evil: he shall preserve thy soul.  The Lord shall preserve thy going out and thy coming in from this time forth, and even for evermore. Psalm 121

Estoy celebrando el nacimiento del Rey de Reyes

“Porque un niño nos es nacido, hijo nos es dado; y el principado sobre su hombro: y llamaráse su nombre Admirable, Consejero, Dios fuerte, Padre eterno, Príncipe de paz.”
“For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace.”

When given the option of Christmas vs. New Year’s, there is no difficulty choosing a holiday to have away from the hospital. In general, our Jewish colleagues hold down the fort while the rest of us pause to celebrate Christmas and then we swap for New Years. Usually everyone comes away happy, perhaps some hard feelings about working Christmas Eve, understandably so.

Reality speaking, working Christmas isn’t the end of the world. Done that before, and I’m sure will do so many times in the future. It just means that I have a job. Many are not so blessed.

Family plays an important role around the holidays. You can walk down any street in America this time of year and find all levels of crazy gathering together. Everything from the single working individual sharing a midnight bone with their animal, to the well-lit and overflowing house operating at all octaves and speeds humanly possible, and.. well.. unhumanly possible I imagine. Perhaps, the parties involved in either situation secretly wishing for the opposite scenario for themselves.  I myself, being far from immediate family, am able to claim my third cousins, who live two hours away, as my family. They’re more than just third cousins though, and it is through our willingness to profess belief in Jesus as the Son of God and Man that brings us together as family.

Whereever December 25th finds me, Illinois, New York, or Timbuktu, whether by myself or with others, I am never alone. And everyday is Christmas. 

I didn’t have the time to get together a Christmas card this year. But as to celebrating the birth, life and death of Jesus my brother, friend and Savior, I wish you all A Very Merry Christmas!

Much Love.

Estoy esperando.

Research day was this past week, Wednesday to be exact. I had dutifully put together an abstract at the second to last minute as is required of us and submitted it. It was accepted for a 3 minute presentation so I picked out some pictures to illustrate the subject and my argument and strung together enough words to equal those 3 minutes.

My Attending stopped me as I was then running out the door to catch the shuttle to go back to the hospital and operate. “What questions did they ask?” He inquired. “None!” I responded. They were more worried about getting on with the next 3 minute presentation, than to wonder at anything I had to offer or say.

I’m just glad it’s over again for another year. Needless to say, research is not exactly my cup of tea.

Much Love.

Estoy limpiando la arteria carotida.

I have often been asked, "What is your favorite surgery?"

I never really had an answer before, and gave some sort of response along the lines of, "I like them all!" I know, I know... eye roll with a side of cliché.  But it was true.

Not anymore!  I love the Carotid Endarterectomy! It is a very sophisticated surgery, and as Dr. Babu says, "It must be done technically perfect." In other words, the stakes are high. But that being said, a very nice Carotid can be completed in an hour or so, depending on the dissection required and if shunting is required. Sometimes 2 - 2 1/2 hours. Not bad for a really beautiful surgery. 

I stayed post call at the hospital this morning to do a Carotid with the Master, Dr. Babu. I'd probably stay post call to do any case with Dr. Babu, but a Carotid... wild horses couldn't keep me away from that. 

Here are a few of my Carotids thus far in residency. The one from this morning is there on top. The plaque extended much further than we were expecting based on the preop imaging requiring us to extend our arteriotomy along the artery both proximally and distally. We eventually just had to say enough, because we could have just kept on going. It delightfully left me with quite an impressive arteriotomy to patch up at the end. Really nice case. And at the end, Dr. Babu thanked me for staying and I thanked Dr. Babu for the opportunity to learn from his technical perfection and improve on my own.

The Carotid Endarterectomy

Much Love.