The “We Did It!” Moment

If today were an episode of Sesame Street, it would have been brought to you by the phrase “You/we did it!”

In the OR today, during my total abdominal hysterectomy, I, apparently, did a better job at skeletonizing the uterines than last week. And, my attending kept going, “There you go! You did it!”

I think she actually said this with every step. As well as, “ok, now keeping going already…”

The OR is like a dance, they say – you should always be moving. Fluid. Seamless. Efficient.

Later in the afternoon, we had a family meeting for a patient. These usually involve multiple teams to discuss a patient’s care and course.

Come to find out, the attending on another service caring for my patient was one of my fellow med students.

[We started in the same class, then I took a research year between 3rd and 4th years, and he did a 3 year residency…if you were trying to do the math on that one!]

It was really interesting to hear him talk, very eloquently, about fluid shifts, electrolytes, optimizing the status of the patient to handle treatment.

It was weird to think back to being in the same hospital as 3rd year medical students and, even further back, in anatomy lab.

I had this secret thought to myself during the meeting. Like “OMG, we actually did this. This doctor thing.”

I don’t think you ever question that you’re going to become a doctor once you enter medical school. But, like they say, the days are long the years are short. I can still see one of my other co-med students, who is now a chief resident, in the library with a huge pile of notecards and me with 16 different colored pens and highlighters rewriting notes after notes after notes (I liked to go through each lecture three times to distill details notes to less detailed notes to bare minimum to then review before the test). And now we like…know things. Its weird. But cool. And empowering. Its also a very expensive process. Beware.

By the way, if you want to know the real secret to learning something….write it down. Over and over and over again.

There is something really powerful about putting pen to paper. It engrains it in your brain.

At least, that is my experience.

Finally, a thought for you people out there — do you think its bad, at a certain age, to have dreams that you know won’t come true, but are cool to think about anyway.

I mean, 29 isn’t old — but it’s not 18.

Secret dream (or not so secret): be a doctor part time and teach high school chemistry part time (is that a thing). I love teaching. I’m not good at many things (do not ask me to cook for you, use your can opener, put something together…), but I think I’m a good teacher. My forte is making good analogies — like the time I compared culturing and identifying bacteria to Facebook stalking guys. Different stains to use? Its like an Instagram filter! Duh…

Anyways, enough about me…

You can tell me your secret dreams. In the comments. Share away!

Speaking of, I’m off to dream world.

Night night…

Until next time…

Daily Coffee Tally: 3 (the 4:15 pm coffee was CLUTCH. I’m going to write that down. I think its going to be a game changer)

Thought Bubbles From The Day

Here are some, but not all:

[with some context for some of them]

*4 am texts from night team regarding admissions* –> “This day is off to an auspicious start – two patients went to OR overnight and another admission…should I start the caffeine drip now?”

*when you’re struggling with a new to you instrument* –> “My hand is not big enough for this! That’s it! Its not me. Its the manufacturer of this instrument.” [After thought — definitely wasn’t holding it right.]

“Is Surgical Solutions a Bellevue thing only? Or is that a company?”

“The OR is like a 3 ring circus sometimes — anesthesia, scrubs, surgeons.”

“Thank God Dr. Lerner knows how to work everything in here.”

“Am I sweating from stress or is the Bair Hugger blowing on me?” (Combination of both)

“Can’t JK Rowling write just one more Harry Potter book?”

“I want more coffee” <– this is on repeat

“I feel like Lupe Fiasco really understands the life of a resident.” (Listen to “The Show Goes On” and “Battle Scars”)

On doing my first total laparoscopic hysterectomy (TLH — THANKS DR LERNER!!!) –> “Seriously, if I can do this, anyone can be a surgeon. Can openers are still hard for me. And, look at me now!!!”

“Written cards really need to make a comeback. Snail mail. Its vintage. Let’s get on board. And cursive writing.”

That’s all.

And, finally, you should read this article that I got from my former favorite fellow (now attending) regarding talking to a patient who is dying. –> Link –> http://m.jco.ascopubs.org/content/early/2015/08/06/JCO.2015.63.4105.full

Night Night.

Until next time..

Daily Coffee Tally: 2

[PS – super looking forward to grand rounds tomorrow – coffee!]

Fight

The US Open started today.

Possibly forgotten fact – once upon a time, I played tennis.

I had an extensive collection of visors. I'll prove it to you….

I had an extensive collection of visors. I’ll prove it to you….

Another visor

Another visor

Another one....

Another one….

I really liked visors… (why? because you can still have a high ponytail!)

I really liked visors… (why? because you can still have a high ponytail!)

Beyond collecting an extensive repertoire of dri-fit gear, one reason you should put your child into tennis, or any sport, for that matter, that you learn how to fight.

In a tennis match, you are alone. There is no coaching. No phone a friend. In addition, unfortunately, in junior tennis, there is also a lot of cheating.

Suffice it to say, you have to learn to stand up for yourself. You have to go and get a lines judge if you think you’re being cheated. You have to learn to fight back when you’re down 4-0 and can’t hit the side of a barn. You learn to fight for yourself because no one else can.

I’m thankful my parents put me in every sport imaginable and that my mom, ever the fighter, taught me, as well, not to back down.

Like, in the 9th grade, when apparently I didn’t score high enough on my 8th grade TCAP or PCAP or Redcap or whatever the Tennessee standardized test is called to qualify for honors English or honors Biology. My sub-par test scores were likely two fold: partially because my middle school was more of a holding pen than place of higher education (although if you could make it at Bearden Middle, you can make it anyway; its tougher than New York) and partially because in the 8th grade I was more concerned with when the GAP was going to get a new shipment in (did I call the store often? Yes…I’ve always been persistent).

I fought to get myself into those classes because I thought I could handle them. I think I got As (if my memory serves me correctly). And, I think I ended up doing ok for myself, academically speaking.

Or, like today, when I got wind of the fact that some of my surgeries I scheduled might be cancelled by SCC. I stormed (literally stormed) up from clinic to SCC (“YOU WILL NOT CANCEL THESE CASES I FOUGHT SO HARD FOR!) prepared to raise some hell to get my cases to the OR.

[Side note: In my head, I was also crafting an email to the head of HHC and, of course, straight to the top – Mayor De Blasio – regarding my frustrations. Don’t go down without a real fight, right?]

[Side note: Also cue Lupe Fiasco’s “The Show Goes On” as the background to my storming up to SCC.]

Sometimes you just have to fight.

Prove you can’t be easily tossed aside. That you’re not disposable.

Ok, that’s all I have to say for today.

Don your Serena cat suits and get your rackets swinging, folks.

You do remember the 2002 US Open Serena cat suit right?

Night night…

Until next time..

Daily coffee tally: 2.5

If I Weren’t On Birth Control, I Would Think I Was Pregnant

Work finally broke me.

I’m two years and two months into this residency thing. And, thus far, I’d say I’ve been pretty good about getting in some “regular life” stuff despite terrible work hours.

Every so often during intern year, I would become overcome by intern year exhaustion and have to take a complete rest day secluded in my bed. In fact, during my vacation at the end of intern year, I slept for an impressive 20 out of 24 hours. I think I could’ve out slept a newborn baby that day.

Today is similar.

I have been on call (i.e. working) every weekend except for one since July 4th weekend. That plus the 2nd week of BGYN (Bellevue Gynecology for those not familiar with the NYU residency acronyms, which is only 29 or so people) has worn me out. I cannot move from this bed. If I wasn’t on birth control, I would be wondering if I was pregnant.

Is that TMI for the internet? Revealing you’re on birth control? Whatever. Gynecologist for contraception! Don’t be whack – contracept!

I mean, unless you are trying to get pregnant, of course.

Since my entry into this world 29 years ago, I’ve suffered from a terrible disease called “afraid of rest,” which I have talked about before on this blog. Apparently, napping wasn’t my jam as an infant (like many) and my mom wasn’t sure why I was so wide eyed and ready to go all the time. Or why I acted like their was something wrong with napping and resting.

I was planning on sleeping some today then getting up to run then doing some work…but all I can do is lie here in and out of sleep. The thought of even getting my nails done is exhausting (this sounds so spoiled, I know). Even TV. TV sounds like too much concentration.

Anyways, despite feeling like I could fall asleep, again, at this very moment, I feel an extreme guilt for not going outside to enjoy the sun, going for a run, or even just doing anything bedsides writing to the world my neuroses regarding doing nothing.

[Who needs a therapist when you have the internet!]

Residency gives you a warped sense of normal work hours. I will end up working 36 hours this weekend. On top of, I don’t know, 48-50 for Monday thru Thursday.

Maybe there is a reason I am so tired.

I think I may go back to sleep…

Until next time…

Daily coffee tally: not nearly enough

Things I Have Learned From SCC

SCC is the “Surgical Coordinating Center,” specifically speaking of the one at our public hospital (that I train at).

This office is the gateway to getting your patient to the OR. SCC loves to make the residents really work for it. You have to really want to get your patient to the OR. Why? Because, inevitably, there are lots of long lines and red tape for these patients. And, you, dear hard working, sleepless resident are there to break.down.those.barriers.

“Mr. Gorbachev, tear down this wall!” <– battle cry of booking resident

I’ve been griping about SCC for the past 6 weeks.

Today, I decided that I could learn something from them.

Here’s a list:

  1. Be unwavering and unrelenting in your rules
  2. There is still a place for fax machines in 2015. Modern technology and ICloud be dammed!
  3. Be very particular.
  4. Be somewhat mysterious.

Before being the booking/BGYN third year, I actually had a strong distrust of fax machines. I mean, where on earth does the copy go and how does it magically end up printed somewhere else?! Its like the ICloud — where is this cloud and where are the faxes going in the air?

I don’t understand old or modern technology, clearly.

Somehow, the zillions of faxed forms to SCC from Bellevue clinic and L&D have made it. I consider this a miracle. I did fax each form twice – once with the area code and once with just the internal Bellevue extension number. Why? Because you can never be too neurotic when you’re having to trust virtual paper transmitted magically in the air.

You know what is also still a “thing” that I have used in my residency? Telegrams.

When you can’t get a hold of a patient by phone or carrier pigeon, there are telegrams. And, they actually work!

I guess life wasn’t so bad before the iPhone…

Anyways, that is all. I am tired. I did two hysterectomies today (THANKS TARANEH AND DR. BAUTISTA, neither of which who will probably see this!). So, that was a big day for me!

I went really risky too – I drank a small coffee AND a full seltzer in between cases to maintain both adequate caffeination and hydration. Fortunately, my bladder did not burst.

Alright, that’s really it.

Night night.

Until next time…

Daily Coffee Tally: 2.5-3 (depending on what you count as a full coffee)

Dear Mr or Ms Anesthesiologist,

First, I am sorry I call you “anesthesia”

Sometimes you switch people. And so when I do remember a name then its a different person behind the curtain.

Do you ever feel like the Wizard of Oz behind there? Behind the curtain.

Because you should. I mean, it fits right? Giant machine. Behind a curtain. You see it, right?

Also, please explain to me this gas situation and how we are all not falling asleep because I’m sure some of that sevofluorane seeps out of the mask and tube.

Next time, can you please also give me an IV and foley catheter. I have never been so thirsty as I am after 7 hours in the OR.

Speaking of, today, after 7 hours in said OR, thanks for letting me sit in your chair while we were on hold for space in the PACU.

Thank you for dealing with the arm boards. I cannot for the life of me figure out getting the arm boards on and off. I’ll stick with the stirrups, you take the arms.

When you put the IV in in holding, insert like 6 emojis above my head, including the hands up and clapping hands emojis.

I’m sorry you have to empty the foley. There is literally nothing I wouldn’t want to do than empty a foley. I don’t know why. I think I’m just afraid of like urine splattering everywhere.

Am I angry you get lunch breaks and get to leave at 4 or 5 if you’re not on call? Yes, yes I am.

But, that’s ok, because you raise and lower the table for me and, if I could, I’d send you a thumbs up emoji for that.

That’s all I have to say for today. I am tired. The OR wore me out.

Until next time…

Daily coffee tally: 1.5 (NOT ENOUGH)

August Makes Me Want To Buy School Supplies

Why must there be so many awesome school supplies and planners out there?

I mean, between Day Designer, Moleskine Notebooks, pens with FINE ball point (I hate medium ball point but I live with it), binder rings (anyone from my residency program will know how much I love binder rings), Korean planners….its all too much.

Speaking of school, the best part of school was getting the gold star, an A, or a good job. For those of us who went to medical school, you extended the ability to earn gold stars and feel good about yourself until your mid-20s.

[FYI – I was once chosen as line leader for three weeks in a row in the first grade. It remains among my top 10 proudest moments in my life. It was the pinnacle of being 7 years old. Did I mention I liked being the teacher’s favorite?]

Anyways, I still seek out a lot of those “gold stars.” If someone tells me “good job,” just insert a thought bubble with the party celebration emoji and an image of me slapping something on my parent’s refrigerator to be like “LOOK, MOM AND DAD, I’M AWESOME!”

This worries me.

I mean, at some point, I’m going to have to stop seeking extrinsic validation and be intrinsically satisfied.

Does this happen at age 30?

Anyways, until then, I’ll be trying to make it rain gold stars.

On another note, I feel like people a lot of time as me about my work schedule and such. And what I do all day.

So, here is last week, in synopsis version. The Cliff Notes of my life…

[For reference, I’m on the GYN service at our public hospital. This is one of our harder rotations as we can get a good amount of consults and have really sick patients, too.]

Monday: Luck out and no inpatients, wake up at 6, run 4 miles, get text that there is a consult, shower and run into hospital by 8 rather than planned meeting time of 8:30, clinic from 9-5, run back to floor and wrap up day with consults and to-dos, sign out at 6, leave at 6:15 (MIRACLES DO HAPPEN!), boxing class

Tuesday: Round at 6:45, Goldstein rounds at 7 (teaching seminar of sorts), OR starts at 8, ultrasound during a T&O (tandem and ovoid placement — for targeted radiation for cervical cancer), do a debulking case for presumed ovarian cancer and GET TO DO THE HYST (insert hands up emoji), finish by 4, wrap up day (consults, to-dos), PM round, sign out at 6, leave by 6:30 (GOD HAS SMILED ON OUR SERVICE THUS FAR THIS WEEK), write down all the steps and notes from the hyst, boxing class

Wednesday: Round at 6:10, ICR (Integrated Care Rounds — formerly know as M&M or Morbidity and Mortality — every department has these, FYI) at 7:15, OR at 9, two laparoscopic endometriosis cases, to do a long endo case, you must have the patience of Job, finish at 4-4:30 pm, wrap up day (consults, to-dos), PM round, sing out at 6, leave at 6:35 (HOW DID I GET THIS LUCKY?), run 6-ish miles with Meagan, read some

Thursday: Round at 8, lots of patients!, run to clinic by 9, clinic from 9-5, run back to floor, wrap up service, lots of consults and new patients, admit a few, sign out at 7 to night team because we were still doing stuff at 6, leave at 7:30, read, no exercise too tired

Friday: conference for 3rd years at 8 while rest of team rounds, didactics 9-12, teaching on insertion of new IUD (Liletta) 12-1, work on booking stuff/floor/consults from 1-6, get sign out on labor floor at 6, on call from 6 pm until 7:30 pm that morning which means we are working and covering L&D/antepartum/postpartum/GYN service/GYN consult pager (there are 3of us – an intern, a 3rd yr, and a chief), lay my head down for one hour two times each, glorious,….goes into Saturday…

Saturday: sign out at 7:30 am, leave at 8:15 am, in bed by 9 am, sleep 9 am to 2 pm, wake up and run with jocelyn who brought me coffee (!), run 10 miles, start to feel really lethargic and heavy at 8 but push through, drink another coffee, work on pre-op list, sleep

Sunday: wake up at 7, work on pre-op list, work on articles to read for the month, order new clogs for bellevue, schedule hair highlighting, talk to family, 11:45 spin with jaws, coffee, whole foods, research, book flights, facial at HeyDay down the strew,(FANTASTIC) because I feel I need to do something outside of my apartment and where I can’t look at my phone or email, talk to family again, eat dinner, ice cream at Mikey Likes It because I really really wanted ice cream (since giving up dessert and decreasing sugar in April, i’ve had ice cream 4 times as opposed to the nightly dessert, something I’m very proud of), write this

Night night…

Until next time…

Daily coffee tally: 2 (one Birch, one Gasoline Alley)