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.

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.

The Second Happiest Day of my Life

Thursday, March 18, 2010 was the infamous Match Day. This is a day when fourth year medical students across the country find out at 11am central/12pm eastern standard time where they will be spending the next 3-7 years of their lives. Four years of tears, sweat, blood, overnighters, and angst, all accumulated into one moment. This moment was shared with 500 of my closest classmates, their friends/family, and my dear friends Lauren and Cory from Houston.

Coming up to that point, I honestly did not feel all that much angst. My first choice was Washington Hospital Center, which was not the most competitive of all the places to which I applied. I also had a fairly reassuring email from the residency director after I emailed her to let her know her program would be my top choice. So, I felt fairly confident. But, the moment I opened that letter onstage and saw the words, "Congratulations, you have matched!" with "Washington Hospital Center" typed just below, I felt an explosion of exhilaration and relief. Finally! After four years of feeling inadequate, always being almost, but, not quite there, I had finally accomplished exactly what I wanted to accomplish, no more, no less.

That euphoria of the second happiest day of my life reminds me of the happiest day of my life, Christmas Day, the tenth calendar year of the life of Alexandra. All year I had been begging and pleading with my parents for a battery-operated car with a shift stick. Christmas came and went that day, with no car. I had received some great presents and was satisfied, but not elated. I thanked my parents and quietly took my presents upstairs to my room. A little while later, my mom called me downstairs. She had our new Polaroid camera in one hand and an undeveloped picture in the other. She said, "I don't understand how to work this thing, the picture is all blurry." I told her she needed to wait for it to develop and proceeded to shake it (Hey Yeah! Shout out to Outkast!). I looked again at the picture and saw it was a picture of our courtyard with a gray, battery-operated Purego jeep sitting outside the window. I then, naturally, looked up to my mom and said, "I don't get it?" She frantically pointed out the window, at which point everything became clear- that courtyard had my Purego gray jeep with a shift stick. I started screaming and jumping up and down then ran for the door. All those months of wishing, hoping, begging, had come to fruition and that initial disappoint that Christmas morning I would yet again have to face another year without my Purego jeep, only served to further augment the euphoria I was feeling at that very moment.

I drove that car a good 50,000 miles around my pool, ran many a carpool, went to many a grocery store/shop/restaurant, and lived my perfectly normal imaginary life with my baby Betsy Wetsy named Beth, in the car seat next to me.

That euphoria I felt match day, though I am still incredibly excited to start this new phase of my life, has dissipated some and lent itself to a new feeling: scared shitlessness. I am excited yet concurrently terrified to finally have real responsibilities, to finally have the power to make decisions that could have potential life and death consequences. There isn't much I can do now, except hurry up and wait, and then bust my ass to do the best that I can come July 1. In the interim, I will dabble in Europe (the next several blog entries) and then will benefit from a prescription of Valium as July 1 approaches to curb the anxiety over the new life I am about to lead.

Best to all,
Alexandra