Farewell...A Tribute

It’s never easy losing someone you love. And even though I’m so often surrounded by death and the families left behind, I realized, no matter how much you try to rationalize, it doesn’t make saying goodbye to someone I love any easier. I got the phone call on a Saturday morning that my grandmother had gone to the hospital for the last time and was sent back home on hospice and not doing well. I was at work and obviously pretty shaken up. I had friends help me find tickets while I tried, in vain, to finish my cases. My attending, seeing how visibly upset I was, said, “Go, go, do what you need to do.” Who said surgeons were heartless? By the time I got home, a friend was already at my door.
“What do you need?” he asked.
“A good cry, and a bowl of queso,” I said.
I got a ticket to Kansas City for 6am the next morning and spent the rest of the afternoon with some incredible friends willing to do anything they needed to help support me.

The next morning I went straight from the airport to my grandmother’s assisted living home. Traditionally, as one gets sicker, he or she must go from an “assisted-living” community to a “nursing home” for higher level of care. But, because my grandmother agreed to hospice, she was able to stay in what had been her home for the last six years, while an outside company came in and helped with anything of greater acuity than for what the community was equipped.

I walked into her room and could immediately see she had hours to days, at best. She looked exhausted. She refused any morphine or ativan because wanted to be fully awake when she saw her family for the last time. When she saw me, her eyes lit up, she flashed a huge smile, and said, “Oh Alexandra! Get over here!” I went over and gave her the tightest hug I’d given anyone in a long time, something I think I needed as much as she did. Some of my relatives were sitting around her bed, and my uncle said, “Oh good. We could use a doctor around.”
“No no,” I said, still working on holding back tears. “I’m not a doctor today, just a granddaughter.”

Nanny was sharp as ever, every faculty intact. She made jokes. She fretted over the hairnet keeping her hair in place. She was always pristine in appearance and refused to wear the same blouse (with matching necklace) within a one week time frame. She fussed over everyone, making sure they had somewhere to sit, got enough food, thought the temperature of the room was ok. Streams of friends and family members came in and out of the room all day long, and nanny recognized and greeted every single one. Nanny always maintained a tough exterior, but on the inside, she had unconditional love for every person in her life.

Later in the evening, my mom and her sister got in, the last of nanny’s children to arrive. Each time someone came into the room, the shock of seeing how sick Nanny looked brought on a new wave of grief. I found that as long as I was eating, I wouldn’t cry. So, every time I started to get upset, I’d just start eating whatever happened to be around me. My mom asked me after she got in, if I had gotten anything to eat yet that day. My uncle, who overheard, said, “Eat yet? She hasn’t stopped eating! Fried chicken, potato soup, trail mix, snickers, sodas…”
“Thanks for calling me out on being a fat ass,” I replied. But I guess he’s not the first to comment on my ability to consume large quantities of food. Hey, everyone deals with grief in their own, special way.

After nanny saw the last of her children arrive, she finally relented to sleep. She slept though the night and we were at her bedside the next morning. However, she never fully ever woke back up. Her heart dropped down to the 40’s and her breathing started to slow until it came to a point she took a breath and then no more. She was never uncomfortable, just appeared to slowly drift into the infamous eternal slumber. I ended up having to pronounce my grandmother because there was no licensed MD or RN on site. Even though I have pronounced people before, it is much different when you reach for your own grandmother’s wrist. I knew full well there would not be a pulse, but still felt a wave of overwhelming grief run through me when I palpated nothing.

This experience is so different from some of the final moments I have witnessed working in the SICU over the last several months of other people’s loved ones. My grandmother died in her room, peacefully, surrounded by people who loved her. I realize hospice isn’t applicable in every situation, but this is my first personal experience with it, and I am becoming a huge proponent of it henceforth. I have had several patients who, despite the fact we know the odds of them surviving are slim to none, continue to be full code. They have a different machine functioning for every major organ system. They have inexperienced residents (yes, I reluctantly mean myself) stabbing needles into their jugulars. They are in horrible pain but we cannot give them too much pain medication because their blood pressure is too low. And, then they die in the company of strangers, pounding on their chest, sending electrical volts through their hearts, with the family pushed out of the room.

My grandmother could have been put in an ICU, started on dialysis for her failing kidneys and drugs for her failing heart, but that would have given her days maybe a month at best? And, odds are, she would have died in that ICU bed, with the nightshift team around her, and no family member in sight. Nanny made it clear she did not want that, so that was not even an option or a decision her children ever had to make.

What are the Odds

My first rotation of second year is coming to an end (the picture is all my fellow second year residents). It’s supposed to be the best rotation, at least in terms of hours, and I have been really taking advantage of my little bit of extra time off. I have greatly enjoyed the breast surgery service. I love that it’s a multidisciplinary setting- we get together once a week- the breast surgeon, the plastic surgeon, the oncologist, the pathologist, the radiologist, the social worker, and discuss the plan of care of each patient individually. I enjoyed the fact that a patient came to you with a disease- a cancer nonetheless- and you could actually cure some of them of it, so they could go on to live many more years. It was nice going to clinic and seeing these patients who were years out from cancer, still cancer-free, with new children, new grandchildren, living full and rich lives. I will miss this service.

Over the weekend, I was out with a friend on Friday night and he asked me if I wanted to go sky diving Sunday. He said he bought it off Groupon and had a two for one deal. Without hesitating, I said, “definitely!” I had been sky diving before in Switzerland, when I was studying abroad in college, and loved it. It’s an incredible adrenalin rush and quite a bonding experience with the friends with whom you jump (years later, I still reminisce about that fateful day from time to time with my fellow jumpers from oh so many years ago). Of course, I did tease him about the safety of getting a two for one sky dive deal and the legitimacy of the company, but I was reassured the company was safe. I made a note to myself the name of the company and thought I better google that before I go, just to be sure.

On Sunday morning, KH picked me up and we headed out to Warrenton, VA. It had originally called for rain, but it was a beautiful day when we got there. There were lots of people out to jump. Even though I had not been contemplating much about what I was about to do, I started to get more excited (and nervous) as I heard the shrieks of people as they landed on the ground and looked up and was reminded of just how high up that plane is when you jump. We waited around for about an hour, then the final group of people before it was our turn got geared up to go. Meanwhile, I noticed a single-engine plane soaring close by pretty low to the tree line. It was one of those planes that lands on water- I kept watching it because it seemed out of place. I didn’t think that there was any body of water around. It kept soaring just over the tree line then started to make a U-turn back towards us. Suddenly, it made a steep nose-dive down towards the ground. The first thing I thought was,” Oh there must be a body of water over there. But that’s weird, those planes don’t do tricks?” It wasn’t until I saw the burst of flames that I realized, that was not intentional.

“Oh my god!” I said.

KH, who saw me staring over him, had turned around to look, “Did that just happen? That just happened.”

“That just happened.” I said.

“Someone call 911!” KH yelled and we started racing over there. Everyone else just seemed to be standing there dumbfounded. I had no idea what we were going to do when we got there but judging from the fact all the employees were hippies with dread locks, I figured we were probably the most well-equipped people there for the situation.

We raced towards the plane, which was about 800yards away. While I was running, I kept thinking to myself, “ok remember ABCs-( first things to check in a trauma)- airway, breathing, circulation.” Then I thought, “ok fire, how are we going to put these burning people out.” I remembered this is why I wanted to go into medicine. Moments like this. I never want to be the person who stands there helplessly in that kind of a situation. I want to be able to do something, to help these people, if at all possible.

When we got to the plane, it was in flames. The front half of the plane was already a skeleton and there were no bodies in there that we could see. I thought maybe they bailed at the last minute, they landed in some heavy grass somewhere. Maybe we should get a search party together. It’s amazing how optimistic the mind is- against all rationale or realistic odds. When I saw the plane going down, I kept thinking of excuses as to why the plane’s trajectory was completely reasonable. Then, when I saw the skeleton of the plane and no bodies, I immediately held on to the idea whoever was in that plane was alive somewhere.

When we didn’t see anyone in or near the plane, we quickly backed away, in case the fuel tank wasn’t hit yet, or there was oxygen in the plane or anything else that could cause it to further explode.

By this point, the rest of the workers had made it to us and the police and fire trucks and ambulances were beginning to arrive. We quietly walked back, there wasn’t much more for us to do at that point. The real rescue team was there now, and from the looks of the plane, it was in the hands of God, anyway.

When we got back to the jump site, KH asked, “So, you still want to go skydiving?”

“Totally,” I said. (Ah, the importance of comic relief to ease the tension). “No! Are you out of your mind?!”

“Ha, ok good, I just didn’t want to be the one to chicken out first… We’ll reschedule.”

I didn’t get my adrenalin rush from diving that day, but I certainly got one. I looked up the crash. They ended up finding the bodies of the pilot and a passenger. They have not released the identities. It’s once again a reminder of the transience and fragility of life that I see so often in the hospital- one second you’re out for a weekend flight and the next is a tragic accident. It again reminded me that your life or the life of someone you love can be completely changed or taken away entirely, in an instant.

A Very Welcome Visitor

I am now officially a second year resident, hallelujah! No more 3am calls for Tylenol. I’m on the Breast Surgery service right now, supposedly the best rotation of the year. It’s a great service. Dr. B is the attending surgeon- he’s a large man with a strong, masculine presence, yet oddly effeminate. He’ll rant and rave histrionically about patients who are late to their appointments or to the OR staff when his cases are behind schedule (which they always are). He fumes that he will NOT see the patient or will NOT do the surgery. He professes that he’s leaving “this godforsaken institution.” But he always does every case. He always sees every patient, no matter how late. In clinic, I go into the room first and see the patient, get the history and do a physical exam. The patients are usually skeptical at first when they see me because they have no idea who I am but they usually warm quickly.

BUT THEN, Dr. B saunters into the room and says in his deep commanding voice, “ Hello! Hello!” And, their faces instantly light up. “Oh Dr. B!” they gush. To most of these people, he’s a savior- they had a cancer that could have killed them and he took it out, saved their lives. He has an air, really of almost disinterest with the patients, but somehow it works beautifully to put the most panicky patient instantly at ease.

One thing I’ve realized on this rotation is that because our training is almost exclusively confined to the inpatient setting, we hardly ever get to see the results of our work. I did have one interaction recently- I was walking back from our weekly conference and I heard a “Doc! Doc!” I kept walking, not even registering it was me at whom this man was yelling. Someone tapped me on the shoulder and said, “I think someone is calling for you.” I turn around and there was Mr. CD- a patient of mine for the entire month I was on the thoracic surgery service. We must have put at least 5 chest tubes in him over the course of his hospitalization.

“Doc!” He says with a big, toothless grin, “I just wanted to thank you for all you done. You all were so good to me.” And he gives me a big bear hug in the middle of the hallway. A little flustered but flattered, I said, “Oh, well thank you Mr. D. You look great!!” And he did. He was walking, talking, still smoking (of course, but less he assured me). Here was someone we thought might never leave the hospital, back to his normal routine. It was incredible to see how much he had improved. It’s been nice getting to see that side on this rotation by going to the outpatient clinics. Those interactions are what give me the fuel I need to keep going, to make me think that maybe I really am making a difference somewhere, somehow.

It is great being in the OR with Dr. B, too, he’ll let you do the entire case, just you and the fellow. He’ll sit off to the side in a chair, dozing off, then periodically wake up and shout, “Young doctor!! What’s taking so long? Let’s hurry! Martini hour is fast approaching!” You don’t want to make Dr. B late for his evening martini. Or if he needs something, “Nursey!!” he will yell, walking down the hall. Instantly, at least one of his harem of devoted nurses will be at his side. He’s trying to recruit me to breast surgery, and I must say, it’s rising on the list.

Victoria came to visit this past week/weekend. We had a great time- went to a fun concert, ate at some fantastic restaurants, went to a true Texas BBQ (oh how I have missed you) with my Texas friends living in Baltimore, the works. It wasn’t until she was here that I realized just how much I missed my family. I, of course, had to work an ungodly amount of hours while she was here. She didn’t mind, after flying all that way, only spending an hour or two with me after work each day before I had to go to bed. While I was working, she cleaned my entire apartment (an old Victorian home broken up by floor into apartments), spotless (NOT an easy task), did my laundry, and decorated, finally unpacking those last boxes. For the first time since moving to DC, I am finally beginning to feel like I have a place that feels like a home to me. The cabinet doors may still fall off their hinges every now and then and there may be a few minor roof leaks here and there, but that’s character...Right?? I was so grateful, but I think what I was the most grateful for was having someone there I love, waiting for me, when I came home at night. She was willing to wait for me till 9 o’clock at night when I got out of the OR to finally have dinner. A friend called me once after getting out of the OR late at night, wanting dinner. I was out in Maryland with friends, but I dropped what I was doing and came back to DC to eat with him, because I get it. You get out of the OR at 9 o’clock Friday night. You haven’t had contact with anyone for the last several hours, you’re exhausted so you don’t want to hit the town, but you also don’t want to just go home alone. You just want someone to go to dinner with or have a few drinks with, so you can feel like you have at least somewhat of a normal existence like everyone else. It was nice to have someone do that for me.

It was really hard for me when Victoria left. After I dropped her off, she texted me and said that she had started crying in the middle of the terminal. That made me start crying, in the middle of the frozen pizza section in the grocery store.
“How embarrassing I started crying,” she said.
“You think that’s embarrassing, you made me start crying in front of the frozen pizza section.”
“Is it because I ate your CPK BBQ chicken pizza?” She asked.
“Victoria, you ate and drank everything in my fridge.” [She did.]

I started thinking that maybe I should transfer to Atlanta. Maybe this will be a little easier to get through near my family, so I’ll have a little more support. Or, maybe this isn’t for me at all. My sister comes for a week and we spend a grand total of a few hours together, is this what I want the next five years of my life to be like? To have a few hours a week with the people I love? It’s been lonely since she left. But, I’ve had a lot of support. My mom listened to be boohoo on the phone…again… A good friend at work sat with me for an hour in the cafeteria, even though she had consults building up and her pager was going off nonstop, just to listen to the same old story. All she said was, “it’s going to be ok.” And that’s all I needed to hear. My good friends far away answered their phones and just hearing their voices made me feel less lonely. A friend of mine from DC recently got back from Africa; he dropped everything and met up with me last night for a dirty martini and some cheese grits. I told him how I felt, that maybe I needed to go back to Atlanta, maybe DC wasn’t for me. “How do you even know?” he said, you haven’t even experienced this city. He was right. Even though I have tried to be as social as I can, I’ve barely touched the surface of this city. I haven’t had the time or the opportunities, really. It’s tough to make new friends at this age. As a DC native, he assured me there was far more to the city than the few circles with which I have been acquainted. I told him he has a year, prove it.

It’s been tough the last few days but sometimes you need the moments of feeling down to realize how much support you really have out there and how many people you have, willing to listen. Sometimes, you just gotta let it out.

The next two weekends I have off. Maybe I’ll go to Dewey beach, true DC Republican style, or go eat crabs by the water in Annapolis (one of my all-time favorite things I’ve done since moving here) or take my friend up on his offer of exploring the city. I’m going to take advantage of my precious time of normalcy these next two weekends to refuel, to get ready for the next wave of 30hr calls and 16 hour work days, to temporarily be a normal person again. Thank you for everything, Fenstermaker. It’s going to be ok.

The Magic Touch

I just got back from my last vacation week of the year in Naples, FL for a plastic surgery conference. After hours upon hours of fluorescent lighting in the hospital, getting there before the sun is up and often leaving after it has already set most of the time, it was nice to spend every waking moment I possibly could in the sunlight. I lounged by the pool, oiling my, already bronzed to the point of calling into question my ethnicity, skin to the chagrin of every plastic surgeon walking by- “Don’t you know better?”
“Yes. And I don’t care.”
Victoria and I signed up for “serenity” massages in the spa. They showed us to the “zen meditation lounge.” There, we were supposed to “take in the tranquility” and become at peace with ourselves. Victoria had no problem doing this- she fixed herself a chamomile pomegranate tea and sat back, listening to Enya on repeat in the background. I sat up on the edge of my chair, legs crossed, shaking my foot and looking at my watch.
“Shouldn't we to tell somebody we’re ready?” I asked Victoria, as she sat back, eyes closed.
“This is the zen meditation lounge. They’ll come when they’re ready. Relax.”
“I don’t know how,” I said. I don’t know how, I realized.
Finally, my masseuse came down and said, “Alexandra, follow me,” in a deep, soothing tone. I followed her up the stairs, trying to make small talk with the woman who was about to rub my naked body with oil, but she wasn’t having any of it. She told me to undress and get on the bed, and left the room. I slipped out of my robe and lay down on the table. She walked in and said, “You can actually get under the sheet,” in that same deep tone, after she saw me uncomfortably posed on the table.
“Oh yeah, of course,” I stammered, slipping under the sheet. Well, this isn’t off to an awkward start at all, I thought to myself.

She started with my neck, rubbing her hands with warm oil. It was the perfect amount of pressure- inciting just enough pain to feel like it was working but not enough to disturb the lull into which I was settling. I thought to myself this probably would be a little better if I had been some hot, young cabana boy rather than an overweight middle-aged woman. But, then again, maybe not- she was damn good. She went down my back to my thighs then to my calves, rubbing the oil into my skin. NOW, I was relaxed. My 80 minute massage, which I thought was going to last an eternity, ended in what seemed like minutes with the ding of a gong. I went back to the zen tranquility room and sat down next to VZ, sipping my post-massage protein smoothie I was given.
“I think I’m relaxed now,” I said. Too bad my resident salary precluded me from weekly $ 200 massages- that would solve the whole relaxation issue.

“You cannot forget how important human touch is. Even if it’s not from an intimate acquaintance, the hug or touch of a total stranger can have a huge impact.”
She was absolutely right. The human touch can be such a powerful force. And although I never considered myself to be “touchy feely”, I was beginning to realize maybe I was more so than I had previously thought. I have noticed the power of touch when dealing with patients and their families as well. Patients notice the way you touch them- I’ve heard them comment when someone comes into a room, gruffly and hurriedly puts a hand on them, perform whatever it is they need to do, then walks out of the room. Versus- the person who sits at eye level and explains his/her actions and proceeds gently and slowly. I had a patient remind me of that once, and I will not forget it. I was post-call, had been up 30+ hours, and had already rounded with my team. It was about 12pm. I just needed to take some staples out of a patient, then I could finally go home and go to sleep. This was something routine that I had already done hundreds of times. I walked into the patient’s room, approached her and started to remove her bandage. She was on the phone, but I figured this was such a simple thing, I’d just do it and not interrupt her conversation. “Whoa, whoa, whoa!” She said, “Can’t you tell me what you’re doing first?” Tired and ready to go home, I had forgotten that something mundane and routine to me was completely novel to her. Now, I really felt like an ass. I apologized, explained what I was about to do, and gently took out the staples. I now try never to forget what’s routine to me can be quite an anxiety-provoking event to someone else. In addition, the manner in which you touch a person does not go unnoticed, and can have a huge impact on how a patient perceives you, even if the ultimate goal is the same. “Touchy feely” may have been "gross" as an adolescent and even looked upon an a sign of weakness. However, with age, I’m realizing not only is it ok, it’s necessary both for my patients and for myself.

Theoretically Speaking

It was finally warm today after several days of cold, raininess. It’s funny how much the ordinary seems so great after a few days of sub-par. My spirits immediately lifted as I walked out of the hospital (before six pm hallelujah) and it was warm and sunny out versus cold and dark, as it has been the past several months. Working so many hours just doesn’t seem as bad when you walk out of the hospital and it is still light out, even though it may still be the same time as usual on your watch.

I’m on thoracic surgery right now, basically surgery involving any structure in your chest (except for your heart). Let’s just say, theoretically speaking, there is one attending- the intern attending (IA). It is a right of passage to work with IA, all his cases get passed onto the intern. It’s the intern’s job to see his patients, round on his patients, and report back to IA about his patients. The upper level residents refuse to work with him. A benefit to this is that often as an intern, you get to help out with much more sophisticated cases than one normally would see. However, if you go into a 2-hour case starting at 3pm, you know you are not getting out of there before 10pm- just another rite of passage.

IA is very methodical- at the beginning of a case, the skin is sterilized with iodine. Normally, the nurse will do it- she uses a foam paintbrush to paint iodine onto the part of the body that is getting the operation. Not IA. IA must prep the body himself. He uses a specific number of strokes and watches the clock as he does so, brushing on the iodine for a specific number of seconds. After prepping the skin, the sterile drapes are put on the patient, covering everything except for the operation site. Normally, the resident will drape the patient so the patient is ready to go when the attending walks into the room, ready to start the procedure. This is appreciated, and expected. Not with IA. If he comes into the room and you have already draped his patient, he will rip them off and shove them in the trash, furious. IA drapes himself every time- with two cover sheets and four towels. Before the procedure, there is a checklist that is reviewed to make sure everything is appropriate- this is called the “time out”. Before every case, IA clears a stool, sets the checklist down, and goes through every check. If you try to put another sheet of paper down on the table that has the checklist, he will grab it, ball it up, and throw it on the floor. Only the checklist is allowed on the table during the time out. Every instrument is held a specific way, every stitch is sewn in a specific manner, every time. If you do anything the least bit off, you can see the anger rising, IA involuntarily furious his set plan has been slightly disturbed. Call it meticulous and methodical, call it obsessive compulsive. It’s not necessarily a bad thing, as long as you are willing to incorporate new and improved methods from time to time into your set ways. In fact, I wish I were more meticulous and methodical. Sometimes I feel like I am way too all over the place- using the wrong drape, forgetting to put on my eye wear, accidentally touching something non-sterile. These are all little details that eventually get rectified, and I know as I get more comfortable in the OR and with myself as a surgeon, all the little details will become routine to me. But, until then, I feel like a total moron at times. Someone at the hospital once asked me if brunette was my natural color. Very funny.

Sometimes, IA will leave in the middle of the case to go have a cigarette. You sit there scrubbed in (i.e. in all sterile gear so you really cannot move) with the scrub tech and anesthesiologist standing there, staring at you. And all you can do is stare back at them, make awkward conversation about the weather or last baseball game, and wonder if it’s possible for lightening to go through 5 floors into the OR, bypass all the metal in the room, and hit you directly so you can get the hell out of the case.

IA eventually comes back in, the tremor in his hand a little more steady. Everyone thinks IA’s hands shake because he needs a nicotine fix. That may be partially true, but I think IA has Parkinson’s. His methodical and meticulous habits are performed in halting, deliberate movements. When he tries to move a stool out of the way, he sets it down stiffly, in a cogwheel like fashion, indicative of the disease. It looks like he his slamming the stool down in anger, but I just think he cannot help it. I don’t think IA has much else going on in his life, surgery is it. And he has a disease that’s making him lose control of his body and of the only life he has ever known.

I think about IA and wonder about the people who think you need to give up everything to truly be a good surgeon (or a good anything for that matter). You have to focus all your time, all your energy into that one specialty in order to be the best you can be at it. To an extent that may be true. But is it really worth the sacrifice to be the best you can be? To spend a lifetime dedicated to a career that a disease or an accident can abolish in an instant? And in the end, who is going to be around? None of the patients that you saved or the clients you helped or the people you defended. In the end, it always comes down to your family and the people who truly love you. With that desire to succeed, if you run off your family or never make the time to love someone or have someone love you back, when you finally get to the top of that ladder, it's probably a pretty lonely place. It most likely takes a hell of a lot of multi-tasking and sleep deprivation to be a great professional, a great spouse, a great parent, a great sibling, a great friend, but I bet it's possible.

Night Moves...End of an Era

It is my last evening of night float. Remember when I said I liked it? I lied. I still like that I meet more people lurking the desolate halls in the evening time than when I’m lurking the packed halls during the day. But, I’m tired. I went from getting up after a few hours, going for runs in the park, getting errands done, having lunch dates…to, well, sleeping then snoozing then snoozing again then snoozing some more, until I had just enough time to wake up, shower, throw together a PB&J (an old flame I recently re-fell in love with), and walk out the door to work. I’m tired of having breakfast at 6pm and dinner at 2am. The workers at Blimpie’s know me by name now (the only place in the hospital open at 2am). I get the same sandwich with the same drink and three chocolate chip cookies every time. They know the type of chocolate chip cookie I want. I hand pick them out- the bigger, chewier ones (that’s what she said?). And they know to go to the back and get me fresh ones if they just made some, instead of the ones that sit by the register all day. I guess there’s something to be said about being a creature of habit (and a total brat when it comes to food…and clothes…and sheets…and pillows…and soap….hmm, I digress). But I can't help it. I've been a lover of food from an early age. My favorite "movie" growing up was Cooking with Julia Childs. My parents encouraged me to watch Disney- I watched the same VHS of Julie Childs make the same 12 dishes over and over again. My mom gave me a list of magazines and told me I could pick whichever one I wanted. She pointed out Sesame Street, Highlights...I went with Gourmet Magazine. I tore out the recipes I liked the most and made files...I was seven years old...no wonder the neighbors asked my parents once if I was autistic.

I have gotten to take advantage of the city a little more this past month. I went to the American History Museum this week and saw the Price of Freedom exhibit as well as Julia Childs kitchen re-created...amazing! I also saw the exhibit about the history of birth control…did you know that it originally came from a root? And, did you know that the government used to try to push birth control on certain populations to curb the procreation of poor, uneducated people? [un-pc comment not inserted here]. I’ve been having lunch dates. LS and I even went to happy hour…because we actually got out of the hospital in time to make it to one. Of course the bar recommended to us that we went to didn’t even have happy hours specials -thanks RR ;) . It’s funny how everyone in this city has this “job” that they can kind of tell you what it is they do, but they can’t tell you too much because it’s “with the government” or a “breach of security.” I decided I was going to leave it vague too:
Cheesy guy to me and LS: “So what is that that you two do?”
AZ: “We work at Washington Hospital Center.”
CG: “So, you two are nurses?” (Of course)
LS: “No we’re doctors.”
CG: “Ha, yeah right, so you mean you’re the secretaries that write the notes for doctors?”
AZ: “I prefer executive administrative assistant, thank you.” (What’s the point of clarifying?)

[I prefer this example- recycled from my days in San Antonio.]
CG: “So what is it that you do?”
AZ: “I’m a dolphin trainer.”
CG: [look of confusion] “Really, where?”
AZ: “Well, I just moved here from San Antonio and used to work at the Sea World there. I recently moved here to work with dolphins for the government.”
CG: [look of greater confusion] “What?”
AZ: “Dolphins are actually very violent, but highly trainable creatures. They eat 7-10 pounds of fish per day. We are training them and beginning to use them in some counter-terrorist activities.”
CG: “Wow that’s crazy.” (People are more likely to believe I’m a dolphin trainer than a doctor…sad…)

Well I’m going to go get my daily dose of chocolate chip cookies! I start thoracic surgery tomorrow, which I’m really excited about. I got my first dose last night when I was in a seven hour thoracics case that finished at 2am. I’m not sure if I liked it because the case was so cool or because the doctor I was working with was a total lunatic and I couldn't stop psychoanalyzing him. Don’t worry, I got a whole blog dedicated to him coming up. And, of course, it will be really nice to re-enter the world of the living and temporarily lay to rest my vampire lifestyle.

Night Moves

I'm working nights now. I've actually been enjoying lurking around the hospital in the wee hours of the morning. The place is stripped down to the essentials. People forgo the petty discriminations between the different resident types- ED residents hating on medicine residents who hate on surgery residents who hate on all of the above. I guess there's a camaraderie that builds between those who can commiserate in the chronic exhaustion that comes from the total disregard for the natural circadian cycle. An extra perk to this rotation is that you get your weekends off- Friday AM I am out of the hospital and do not come back until Sunday evening. What scares me is that I have no idea what to do with myself with all that extra time. My social skills are on the decline. I feel like I'm missing something or doing something wrong if I'm out of the hospital for longer than 24 hours. The hospital is beginning to feel more like home to me than my actual home. That scares the hell out of me.

The premise of night float is to be on call for all of the surgical patients in the hospital overnight- two interns care for all the floor surgical patients and the Senior House Officer (a third year resident) takes care of all the ICU patients and oversees all the new surgical consults that happen overnight. One of my closest friends here, LS, is on night float with me right now. Some nights are quiet some are non-stop- you never know what you are going to get. The other night we had a patient that LS was called about for bleeding. The patient was a plastic surgery patient, and I had been in her initial debridement surgery so I came up to see what was going on. She'd had multiple debridements for a sternal wound infection after cardiac surgery. She had been in the ICU for the last several weeks but was now doing well on the floor. Earlier that day, she was doing fine, sitting up in a chair, talking to her children. Now she was acutely decompensating. She went from being responsive, complaining of pain to not responsive to hypotensive. We called anesthesia stat and started taking out the staples and stitches out of her sternal wound. Blood started pouring out. We called a code yellow- a code trauma- it quickly gets the trauma surgeon to wherever you are as well as all the personnel needed to create a mini operating area. Her heart rate went into the twenties, so I started doing chest compressions, while LS kept working at removing the sutures and attempting to find the bleeding. The cardiac and trauma surgeons arrived, as well as the plastic surgeon who had performed her most recent procedure. They were all standing around the woman's bed, trying their best to stop the bleeding and figure out what the hell to do next. With her veins being pumped full of blood and sympathetic drugs, we wheeled her down to the OR. The cardiac and plastic surgeons worked at stopping the blood vessel that was bleeding, while I worked on an arterial line on side of the groin and LS worked on a central line on the other. Finally, the anesthesiologist called it- she had zero blood pressure, zero cardiac output, further attempts at saving her were futile. Time of death was called. The graft had become infected and torn right off the aorta- the cardiac surgeon said the tissue was so far gone, she never would have made it. Everyone stood there in silence over the woman's body, while the remaining ounces of blood continue to pour out of the hole in the woman's aorta. There was nothing more anyone could do. I sewed up the gaping hole in her chest and we cleaned up the blood to make her presentable to her family later.

My heart was still racing. Although I wanted to be right in the middle of that situation so I could learn as much as possible and learn what I could do to act more quickly and effectively next time, I began to feel ashamed. This woman, lying there on the table with her chest wide open, wasn't a science experiment. She wasn't a practice dummy to make me a better surgeon- she was someone's wife, someone's mom, someone's sister. I thought back to when I first walked into the woman's room for her initial consult. I tried to remember the faces of her daughters, the hour I spent with them, telling them that we were going to do a simple debridement, that the infection looked rather superficial, that she was probably going to be ok. Now I looked at the woman on the operating table in front of me- I had lied to them. Not intentionally, but a lie nonetheless. Their mom did not end up alright, and I had been excited at the acuity of the last moments of their mother's life. It's amazing how quickly the humanity leaves and the cold intellectualization sets in during those moments. That scares the hell out of me too.

I'm Back!!

It's been a long time, friends. I get home every day and think to myself, "man, what happened today would be a great story for my blog." Then, I look at my jar of Nutella on my kitchen counter then at my bed and go for my typical routine: a few spoonfuls of Nutella into my mouth for dinner, maybe a few minutes of reading or Glee (guilty pleasure) and then my delicious bed. On a day to day basis, the last six months could not possibly have moved along any more slowly. On a lump sum basis, these past few months have flown by. Do I feel like a surgeon yet? Absolutely not. Do I feel like a doctor yet? hmmm getting there. Do I feel like I have aged decades over the last six months? Absolutely. I'm getting wrinkles. My hangovers are way too horrendous to go out much anymore (at least relatively speaking). My knees ache when I walk up and down the hospital stairs too many times. I wear compression stockings whenever I go to the OR because I'm starting to get spider veins. Hot, huh?

I've both loved and hated the last few months. The amount I have learned/am attempting to learn is unfathomable. Every day I learn something new...which translates into: every day I make a mistake, get yelled at, and now wont make that mistake again. It's exhausting and exhilarating. Some days I leave the hospital in tears. Some days I leave feeling on top of the world- nobody can bring me down- until I run into an upper level resident and get yelled at for something- then I'm back on the bottom of that mountain, face down in mud, still attached to my rappel rope, ready to give it another college try.

I'm going to start trying to share stories. The craziness of this world really shines in a giant community hospital. Just when I think I cant see anything worse or hear a more horrific life story or witness a more heroic deed, I prove myself wrong. I'm excited to re-open this blog and share with the people who care to read it. I used to joke to people, "yeah you think it's all Gray's anatomy, but it's not at all." I was wrong...it's totally Gray's Anatomy- the ridiculous medical scenarios, the inappropriate love affairs, the highest highs/lowest lows all in a 60min primetime show slot--it really happens.