ACE

I'm just a student, I'm just a man, and I may not change the world, but let me inspire someone who can...

[docedace]

Doing what’s convenient should never get in the way of doing what’s right.

[docedace]

Connected.

There is a species of jellyfish that exists just in one lake on this entire planet. Every morning, before the sun rises, these jellyfish travel to the surface of the lake so that algae that live within them can photosynthesize and produce glucose for the jellyfish to survive. Every day, they travel from east to west, chasing the rays of the sun, chasing their hope for survival.

Every night, these same jellyfish sink to the bottom of the lake, where oxygen is so limited that they risk dying. At the bottom of the lake, the oxygen-poor water is rich in nitrogen, which in turns, feeds the algae that worked all day to feed them.

Connected.

Spring time in Africa is known for its dust storms. Every year, hundreds of millions of tons of this dust gets picked up by the trade winds, make their way across the Atlantic Ocean, and land on the Amazon basin. This dust is the remnant of dried river beds; beds made up of diatoms and dinoflagellates and other microscopic creatures that create the oxygen for all life on Earth.

When these tiny creatures die, they sink to the bottom and create a layer about a half-mile thick on the river floor. Over millions of years, as the water recedes, the river beds dry and become a desert. This desert dust is what gets lifted by winds, and make their way to the Amazon. It is the skeletons of these tiny creatures that once created the oxygen for us to breathe that then give life to new plants and trees by serving as fertilizer. It is this dust from the Sahara in Africa that is part of the reason that the Amazon is so fertile.

Connected.

You see, all life on Earth is in a delicate balance. And whether we realize it or not, our daily commute to and from home is not very different from the simple stingless jellyfish in the lake. We live in a world so connected that dust storms in Africa affect soil quality in the Amazon, and an entire species of jellyfish would die if the nitrogen content in the water shifts every so slightly. We are all connected.

One night, I received a call from the intern covering cardiothoracic surgery. He was worried because a patient had been having consistent runs of ventricular tachycardia, a heart rhythm that would not allow the heart to pump with enough coordination to get blood to vitals organs. I was covering the intensive care unit, and told the intern to check the patient’s electrolytes, obtain an EKG, and place pads in case he needed to be defibrillated. Shortly after the call, I heard a “code blue” called over the hospital intercom, in the same location as the patient.

And I knew.

When I arrived, the medicine team had been beautifully running a code, like perfect synchronized divers. I found out that the patient had undergone coronary bypass surgery a few days prior, and was scheduled to be discharged home the next day. He was still in a non-perfusable rhythm. I called the attending, who told me to prepare the patient for ECMO.

“Do not stop until I get there,” he said.

While the medicine team ran the code, I placed two central lines, one in his femoral artery and one is his femoral vein, and waited. The attending arrived, and we placed ECMO cannulas and connected him to the circuit.

82 minutes later, blood left his body, traveled through this machine which provided oxygen, and re-entered his body, like the delicate cycles of nature.

We brought him to the intensive care unit, where the nurse called out that the patient required sedation.

“Sedation?” I thought. He may have suffered anoxic brain injury so severe that he might not have any brain function. I go into the room, and call out his name.

No response.

I told Sue, the patient’s nurse, to hold off on the sedation until we can assess his brain function. And before I could finish the sentence, he rose his hand off the bed, and gave me a thumbs up, as if he was still present, as if he was still connected.

What we do every day is not good luck. It is not a miracle. It is not God’s work. It is neither magical, majestic, nor marvelous. What we do is restore function if we can, and keep those afflicted connected.

It is time to realize that this work goes beyond the trauma bay, the operating room, and the hospital ward. The connections that we have with each other are vital for this planet to continue functioning, and for our species to even remain present here on this Earth.

We are all brothers and sisters and husbands and wives and fathers and mothers and daughters and sons. And just like the dust in the Amazon, our remains will eventually create fertile ground for the next generations.

Our only job here on Earth is to stay connected to one another, and stop letting our differences set us apart. Because in the end, like the jellyfish and the algae, what we do for others is what will keep us alive.

Connected.

[docedace]

Today, I hugged a stranger.

Today, I hugged a stranger.

And I didn’t know his name.

We had just operated on a young man, probably in his late teens.  He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition.  When he lost pulses in the trauma bay, we cut his chest open and spread his ribs.   His lifeless body laid there as we held his heart in the palm of our hands, and pumped it – over and over again – to mimic life.

We pumped his heart tirelessly, afraid to let go, afraid to give up, afraid to say ‘enough’. And just when we thought we had lost him forever, a flicker of hope jarred us as his heart began to beat again.  We rushed him to the operating room, and a team of anesthesiologists, nurses, and residents met us in the room.  We worked together quietly and efficiently, all too well rehearsed.

“Male in his late teens, multiple gunshot wounds to the thorax and abdomen.  He has a left femoral cordis, and two large bore peripheral IVs.  A resuscitative thoracotomy was performed in the trauma bay.  Aortic cross-clamp time was 2053.”

That was all the information they needed as we worked to put him on the table and prepare his body for surgery.

In two hours, we were not able to control the bleeding.  He was in critical condition.  We packed his chest, and temporarily closed it.  He will need massive resuscitation in order to survive more surgery.

I was unsure if we would save his life.  I was unsure if this young man - in his late teens - will ever grow to get married, have children, or see the colors that form when the rain meets the light.  I left the operating room, defeated.  

And there he was – sobbing in a corner, alone.

He was in his mid-40s, wearing a grey shirt and muddy boots.  Judging by the mud on his soles – remnants of the rain mixed with the Earth - I can tell he worked in construction.  He had a muscular build, and by the smell of his shirt, I can tell he was working all day.  I walked up to him as he held his face in the palm of the hands, and I stared as single tear drops fell onto his worn jeans like summer rain. And I grabbed his head and pulled him into my chest.

I embraced this stranger as he sobbed into my chest, leaving behind small little patches of despair and pain.

Today, I hugged a stranger.

I hugged him with the hope that I can lift some of this pain from his shoulders, with the hope that I can take on some of the burden of his hopelessness.  And I felt my eyes well up with the same pain, as I thought of my patient – a male in his late teens with so much to live.  As I held him, I felt his sobs move to a slow whimper.  I wiped my tears, and walked away without saying one word, without looking at him in his eyes.

I went to a nearby bathroom, and sat on the floor.  I needed time to think, to feel, to gather myself.  After a few minutes, I washed my hands, washed my face, and walked back to the operating room to check on the patient.   The chief resident on the team had re-opened his chest, and was massaging his heart.

“He lost pulses,” she said, as she motioned me to take over compressions.

I pumped his heart in the palm of my hands – over and over again – to mimic life, but his heart laid still.

Everyone went quiet.  

We bowed our heads in understanding.

___________________________________________

I stood behind as the team left to prepare for new cases.   The air was warm and thick in the operating room as I cleaned his motionless body of blood.  The nurse and I moved his body onto a stretcher – his bloody Tommy Hilfiger boxers remained on the operating room table.  We worked together quietly and efficiently, all too well rehearsed.

The phone rang – like an old, nasty alarm clock – and pierced through the thick air.  It was another nurse on the line telling us that the family has arrived, and wanted to see the body.

We wheeled him to the recovery unit, and the nurses prepared the room with boxes of tissues and cups of water.  I took one last look at him before I departed, and felt my eyes well up with indignant pain – another young victim of gun violence, taken too soon.

As I leave the room, there he was walking toward me, toward his son’s body – in his grey shirt and muddy boots.

He took one look at my eyes, and embraced me.  He pulled my head into his chest, and by the smell of my scrubs, he could tell that I was working all day. He embraced me as I sobbed into his chest, leaving behind small little patches of hopelessness and pain.

Today, I hugged a stranger.

[docedace]

What hell feels like...

I walk up to the ICU. Ecstatic.

I just placed a subclavian line, a chest tube, and performed a bronchoscopy on my patient. Intern year is going well, and today is a great day.

For me.

I have been learning so much, been trusted to do even more, and been a part of gratifying experiences. Successes. Life changing procedures. Things that still make me sit in awe that we can transform the human body, alter physiology, and still have good outcomes.

It is a good day.

For me.

As I walk into the ICU, I see an old man - likely well into his 70s, judging by his pronounced wrinkles and magnetic gait - with tears in his eyes, sucking in air, walking as fast as he can to the exit, silently sobbing.

I stare. But I can offer nothing.

As I approach my patient’s room, I am greeted by the ICU attending, who curtly tells me, “she suffered an infarct of her right MCA. It’s unsurvivable. Her family just withdrew care.”

And I knew.

It was a good day. Only for me.

I immediately knew that he was the family.

I immediately knew that he was the one she chose to carry out her wishes.

And I immediately knew that he ran out of the unit to cry his most horrifically provoked cry, knowing that he will never get to say goodbye to his wife again.

And just then I realized what hell feels like.

To know that I will never know her circa 1965 when she dressed up to attend a ball, or how he asked her to marry him, or how it felt to be a part of their first family picture, or how it felt to buy their first house together, or how they ended every single day with a good night kiss.

I will never know.

But what I do know is how his face was contorted into a true expression of grief. And how he held his breath to keep from crying. And how he ran out of the ICU so that we wouldn’t hear his wails of fear, anger, and grief.

I will never know how they were together. And I will never be a part of what they were. I will never know how they loved. And I will never be a part of their beginning.

But I was a part of how they end.

That’s what hell feels like.

[docedace]

People are not snow, or rain, or autumn leaves, or waterfalls. They do not look beautiful when they fall. Lend a hand or three.

[docedace]

Eyes.

I walk - coffee and census in hand - to my patient’s room. I never met her, so I begin my skepticism and study of ‘what ifs’ on the way. What if she doesn’t trust me? What if she’s really sick? What if I don’t know how to help? I set aside my apprehension and doubt, and I begin to read her story, ”47 year old female with a past medical history of hypertension, presents with…” I hear someone approaching from the other side of the hallway, and I stop reading to do that friendly smile that I like to do to acknowledge someone’s existence. And just as my eyes meet his, my heart sinks to the soles of my feet, through the floor, and becomes trapped in a wooden box deep beneath the foundation of the hospital. He smiles back, but his eyes tell a story. A story of worry and sorrow and anxiety and worry. And worry. He smiles back, but I don’t see honesty. I see deceit and an attempt at cordiality. I see pain and an almost disdain for me, for people in white coats, for people that are supposed to help him and his situation. He smiles back, but I see different emotions behind those dreary, hopeless eyes. I see his eyes rimmed with dark circles, and I wonder if he’s slept at all. I see a yearning for escape. I see a person too broken and too distraught to smile with conviction. He smiles back, but I see that he’s disconnected. And in that moment, I see my father, my uncle, my brother-in-law. And I want nothing more than to hug this stranger, and try to wrestle some of his pain from him with my embrace. He smiles back, but his eyes don’t smile. I walk further down the hall, and I couldn’t help but look back at him and observe his posture, his gait, his existence. I press the button for the elevator, and stare at the story on the paper, trying to read, but far too affected for the words to register. “47 year old female with a past medical history of…." I stumble on that line as the elevator climbs to the ninth floor. "47 year old female with a past medical history of…” I find myself at the door to her room. I walk in, and I take one look at her. And somehow I know that I just met her husband downstairs. Those eyes.

[docedace]

Life

Finding the most beautiful balance between realizing that you don't know everything, and realizing that you want to...

[docedace]

Just Another Page

And not on the beeper that we carry when we staff the consult service. Not that page.

The pages of our census, where we so eloquently minimize entire lives into broken sentences, and fragments of ideas. Those pages.

Where we scribble down notes and write ‘to-do’ lists. Where we write labs and most recent vitals to assess a patient’s response to our treatment. Where we write all of the information that runs through our team on a given day. Pages so valuable that there is no wasted space. No extra patients. If our job is done, “off the list”.

And it’s condescending to minimalize an entire life onto those pages. But we do it because we need to. Because without those pages, our day would come to a screeching halt, and a frenzied panic would set in when you realize that you’ve lost all of the plans, all of the notes, all of the labs, all of the vitals.

Pages so precious that if a patient expires, we rip the page off to make room for more.

Just like that.

A rip of a page, and gone are those unneeded notes.

But those pages. Those are the pages I’ll never forget.

Those pages are where the learning happens. Those pages are where deep reflection settles in. Those are the pages that are embedded into my memory forever.

Because those are the pages - although ripped off and tossed away - those are the ones that I never, ever want to see ripped off again.

[docedace]

Flood in Tbilisi, Georgia killed hundreds of animals trapped in a zoo. Hundreds of exotic animals, trapped in an unnatural habitat. I’m sure there were no people around trying to help them. Most drowned to death. Imagine their panic, probably comparable to our feelings during a major catastrophe. Lost and alone. The only difference is that those who survived were shot, tranquilized, and recaptured.

How can we expect to treat each other with respect when we still have a giraffe in Philadelphia living in captivity? You see, when a person understands the pain that an animal feels when its separated from its family, its surroundings, its home, then MAYBE, just maybe, we could understand the pain we bring each other with certain words and actions.

#foodforthought

[docedace]

many May miracles.

matched. married. graduated. homeowner.

[docedace]

Love & Oceans

“You’re like the ocean - pretty enough on the surface, but dive down into your depths and you’ll find beauty most people never see.

Lucky, lucky me.  I fell in headfirst.”

[docedace]

I MATCHED!

[docedace]

I won't complain, thats too easy. Its harder to be the one to make a difference.

[docedace]

Medellin, Colombia Part II

In Medellin, the curtains in the hospital room that divide the patients are seldom drawn. In Medellin, the curtains are wide open. Patients talk to each other, they see each others scars, they see each others bodies, they see each other when they are most vulnerable. Visitors talk to other patients. Visitors talk to other visitors. And it's this sense of community that promotes healing - if not physically, mentally. When rounding, we seldom draw the curtains, because the doctors understand that the neighbors already know what's going on with the patient, and so do their visitors. And when we leave, there will be a whole discussion about their sickness, and about how they are going to get better, and about what we just said, no matter what the prognosis is. Here, you rarely see someone break down when given bad news, because here, they know that they have an entire country to back them up.

[docedace]

We live in a world that is so judgmental - where some would rather die than be who they are.

But, life is too short to live it the way others have planned for you.

Find yourself, and hold on to it. Fearlessly. Forever.

[docedace]

Medellin, Colombia

So I decided to do an international surgical rotation in Medellin, Colombia for 2 weeks. Its currently my second day, and already I’ve discovered so much about myself, and about the doctor I want to be.

I speak Spanish, but I’m not nearly as fluent as I should be. I know the language. And I understand it. But I am rough around the edges. Sometimes, my cerebral processing time is just a little slow when I need to find the right words.

Being here - in a Spanish speaking country - I have learned how disconnected someone can feel when they don’t understand a language. I understand how hard it is to express your feelings, how difficult it is to express your thoughts. You lose opportunities to conversate. You lose the ability to be yourself. You lose your personality.

I have never felt so liberated, but yet so lost. When you don’t speak a language fluently, there’s only so much that people expect from you. But, with that permissible ignorance also comes the inability to get your questions answered. Liberated, but lost.

These feelings of liberation and feeling like a complete idiot at times has reinforced the importance of taking time with patients, particularly those who speak a different language or those who are sensory deprived. If you won’t listen to their concerns and answer their questions, who will?

Doctors in Medellin are probably the friendliest and happiest people in the hospital. They are a beacon of hope, a symbol of happiness. Their bedside manner is welcoming and warm. They answer questions, they take their time. They get to know the person behind the disease. On rounds, when presenting a patient, you will be chastised if you don’t mention where the patient was born, where they are from, how many children they have, if they are married, where they work. This is the most important part of the presentation, and shows how the culture of the people is part of medicine.

The culture here is one that cannot be expressed in words or pictures. Its engrained in souls. Here, you rarely see someone in their home watching television. Instead, their front doors and windows are open and they are sitting in a circle talking, catching up, eating, having a few beers. Every patient in the hospital has a visitor. Every patient has homemade food. Every patient is smiling.

There are stark differences in the way things are done here in Colombia, as opposed to the United States. Patients present with diseases at later stages, there are differences in management, there are fewer resources. Surgery gowns are reused, there are limits to the number of sutures that can be used in a procedure, sterile fields are taken down, washed, and reused, and gallbladders are pulled out with a condom during a laparoscopic cholecystectomy.

But despite the limited resources, physicians are well trained and patients do well. Despite late stages of disease, patients are smiling.

The culture is rich with simple gestures. People greet you with a cup of coffee. Everyone says ‘good morning’. People hug, they talk, they offer help. Every neighbor knows each other; they know their names, their families, their pets. People celebrate birthdays with a picnic. Children play soccer in the streets. Its a simple life, full of joy.

And its this very culture that is displayed throughout this hospital, from the doctors to the nurses to the patients. Despite the somber surroundings, it is a happy place.

And if I bring anything home with me from this trip, it’ll be a sense of humility that I have never appreciated. Although I can’t bring a whole culture home, there are some aspects that will live with me forever.

I am forever indebted to this place.

Medellin, Colombia

[docedace]

Never let someone form an opinion of someone else for you. Get to know everyone, learn from them, be kind, be humble. Because it is the people you least expect that will often do the most for you.