Thursday, July 01, 2010
Day 1
So far so good. No one has died, I haven't committed any egregious errors in management, and my co-residents and I don't hate each other. It's pretty great being able to go to the OR without the dread of knowing that as you're there the floor work is piling up on you. I was "operative" today, so I was able to do my two cases and let the other guys take care of the floor and ICU. Pretty awesome.
Wednesday, June 30, 2010
A Journey of a Thousand Miles...
usually starts with a flat tire and a broken fan belt.
Well it's official. We just had our orientation for our R2 year of neurosurgery. Amongst all the other info we received today, we got our business cards, loupes (those fancy OR glasses with telescopes in the lenses), call schedule, team assignments, and a whole lot of "good luck, you're going to need it."
This year was the reason for which this blog was created. It's purportedly the hardest year of residency we could ever imagine. Listening to the instructions from our attendings in regards to the "back up" we'll have during our first few weeks on call made it sound like we were preparing for war or some great natural disaster. The way the more experienced nurses are heading off to vacation and how the attending surgeons have ceased operating silently reaffirms the huge white elephant in the room: new interns, new R2s - don't get sick, because all around the US during the month of July in academic institutions people die. It's a well known fact that everyone gets promoted during this time. The residents that only months earlier were marching to the beat of a seasoned chief resident now are asked to call their own cadence. The residents who only days before, separated by a week of debauchery and drunkeness, were mindless work horses known as interns, are now expected to make clinical decisions and perform surgery - albeit under close supervision. And the medical students who only weeks before were still strictly book learned and green, are now scrambling around the hospital with their heads cut off like chickens, but still trusted and referred to as "doctor." Yea, now's not the time to be ill.
That being said, if you do find yourself in the hospital at this time, be assured that everyone is hypervigilant. Everyone's work will be checked, rechecked, and checked once more over as no one exactly trusts anyone to do their job completely right. They say that Christmas is a bad time to be in the hospital as that's when residents get overconfident and too big for their britches, making decisions they can't support or correct when things go wrong. So that elective surgery you were thinking about? Yea, I'd shoot for sometime in October.
But I digress. Back to neurosurgery. 337 days, 48 weeks, 116 overnight calls, 200 operative cases, and one soul to preserve throughout the whole ordeal. It's exciting, but let's face it, it's scary. Although all medicine/surgery has its risks, neurosurgery is one of those fields where if you get lazy, sloppy, or lose focus for even a second, someone could die. Perhaps a little melodramatic, but unfortunately true. But hey, it keeps things interesting.
Well it's official. We just had our orientation for our R2 year of neurosurgery. Amongst all the other info we received today, we got our business cards, loupes (those fancy OR glasses with telescopes in the lenses), call schedule, team assignments, and a whole lot of "good luck, you're going to need it."
This year was the reason for which this blog was created. It's purportedly the hardest year of residency we could ever imagine. Listening to the instructions from our attendings in regards to the "back up" we'll have during our first few weeks on call made it sound like we were preparing for war or some great natural disaster. The way the more experienced nurses are heading off to vacation and how the attending surgeons have ceased operating silently reaffirms the huge white elephant in the room: new interns, new R2s - don't get sick, because all around the US during the month of July in academic institutions people die. It's a well known fact that everyone gets promoted during this time. The residents that only months earlier were marching to the beat of a seasoned chief resident now are asked to call their own cadence. The residents who only days before, separated by a week of debauchery and drunkeness, were mindless work horses known as interns, are now expected to make clinical decisions and perform surgery - albeit under close supervision. And the medical students who only weeks before were still strictly book learned and green, are now scrambling around the hospital with their heads cut off like chickens, but still trusted and referred to as "doctor." Yea, now's not the time to be ill.
That being said, if you do find yourself in the hospital at this time, be assured that everyone is hypervigilant. Everyone's work will be checked, rechecked, and checked once more over as no one exactly trusts anyone to do their job completely right. They say that Christmas is a bad time to be in the hospital as that's when residents get overconfident and too big for their britches, making decisions they can't support or correct when things go wrong. So that elective surgery you were thinking about? Yea, I'd shoot for sometime in October.
But I digress. Back to neurosurgery. 337 days, 48 weeks, 116 overnight calls, 200 operative cases, and one soul to preserve throughout the whole ordeal. It's exciting, but let's face it, it's scary. Although all medicine/surgery has its risks, neurosurgery is one of those fields where if you get lazy, sloppy, or lose focus for even a second, someone could die. Perhaps a little melodramatic, but unfortunately true. But hey, it keeps things interesting.
Tuesday, June 22, 2010
Tripped at the finish line
Two days left in intern year, post call, and I start getting fevers and chills in the cafeteria. No biggie, probably just a flu or whatever. I get home and then ensues the worst 24 hours of my life. Fevers, chills, rigors, nausea, vomiting, intolerance of oral intake more than 10cc. I seriously thought death was upon me, but if it wasn't I seriously wished it would come.
That being said it was a pretty disappointing way to end intern year. My senior residents tell me about how they get through residency without a single sick day, and I land one right at the finish line before my first year. I feel pretty weak, but honestly, I think projectile vomiting is where I draw the line.
Still, last day of intern year coming up. Hurrah hurrah!
That being said it was a pretty disappointing way to end intern year. My senior residents tell me about how they get through residency without a single sick day, and I land one right at the finish line before my first year. I feel pretty weak, but honestly, I think projectile vomiting is where I draw the line.
Still, last day of intern year coming up. Hurrah hurrah!
Friday, June 18, 2010
always remember, and never forget
I used to be a fairly sentimental guy. I'd listen to the slow jams, be able to turn any spoken word into prose, and mentated little phrases and speeches on friendship, love, loyalty, etc... I was a humanist in some sense, an anthrope if you will. But the more I isolated myself in my books and labs, the more I lost touch with people, obviously. But I guess the thing that bothers me upon reflection is that it doesn't really bother me at all. Well at least until today. I forgot my best friend's birthday, second year running. Last year it was because I was in the middle of intern year orientation, and the days were a frenzy of new people and information. This year I'm actually an intern, and being on call running around the hospital isn't the most conducive setting to allow for reflection on the people in your life. Not that she's an all star best friend either (yes you know what I'm talking about), having forgotten my birthday as well last year. Though I'm convinced she just pretended to to make me feel better about forgetting hers... she would be that kind of friend if she were smart enough to remember things, but she's pretty dumb actually, so more likely than not she just forgot (:
With sleep deprivation comes memory consolidation problems. I don't remember much of anything anymore. If it's not on my patient list sheet with my boxes of tasks to do, labs to follow up on, radiology studies to get reads on, patients to discharge, notes to write, orders to order... if it's not there, I don't "remember". This piece of paper is my brain, it's the only thing with information worth keeping throughout the day. My life utterly reduced to check boxes of people I do not know, nor will ever meet again once they leave this place. And yet there's no check box for calling my best friend on her birthday. I wonder if being a great doctor means you suck as a person outside the hospital? People say it can be done... but I obviously have a ways to go.
Clearly, I'm not fit for human consumption.
With sleep deprivation comes memory consolidation problems. I don't remember much of anything anymore. If it's not on my patient list sheet with my boxes of tasks to do, labs to follow up on, radiology studies to get reads on, patients to discharge, notes to write, orders to order... if it's not there, I don't "remember". This piece of paper is my brain, it's the only thing with information worth keeping throughout the day. My life utterly reduced to check boxes of people I do not know, nor will ever meet again once they leave this place. And yet there's no check box for calling my best friend on her birthday. I wonder if being a great doctor means you suck as a person outside the hospital? People say it can be done... but I obviously have a ways to go.
Clearly, I'm not fit for human consumption.
Wednesday, June 16, 2010
sleep psychosis
You know there's something wrong with your life when you're excited to get 2 hours to sleep. Well that's where I am. Sunday night, 30 minutes. Monday night, 30 minutes. Tuesday night, 2 hours... hurray.
And yet, I'm blogging... to be continued, must get some z's.
And yet, I'm blogging... to be continued, must get some z's.
Wednesday, June 09, 2010
Last Supper
The neurosurgery seniors took the incoming R2s to a really nice steak dinner today at Mastro's. Although the premise was that of indoctrination and forewarning of the responsibilities of the upcoming year, my fellow R2s and I saw it for what it really was - a last supper for those on death row. Listening to my seniors talk about their experiences as the neurosurgery R2 over the past years was simultaneously comforting and disconcerting. Hearing that there's layers of back up, that they'll be there to answer every simple question in the first few months, that we essentially weren't allowed to make any management decision on our own initially... those things were of great comfort. That we'll undoubtedly fall asleep in the OR (which I've already done multiple times), screw up, upset attendings, etc. Fine, whatever. "You will kill people"... almost in jest, but with enough preceding sincerity that you know they're being truthful... that was kind of sickening.
I've heard the stories (none of these from UCLA btw): elective spine cases where one wrong slip leads to quadriplegia in an otherwise healthy gentleman; plunging into the aorta in a lumbar fusion case causing the patient to bleed out on the table; taking too much tissue in a epilepsy case that results in hemiparesis - these are the catastrophes one never thinks will happen to him, but invariably WILL happen if you're in practice long enough. In poker they say you don't always remember all your great wins, but you definitely remember the terrible losses, the bad beats, the hands that leave your pockets empty and hearts cavernous as you get up to leave the table. It's only natural for surgeons, at least the good ones, to remember the tragedies, as they're hopefully few and far between.
After being an intern in the hospital for a year, sure, I've seen people die, often in front of my own eyes. Good people, healthy people, the ones you expected to walk out of the hospital the next day. But no one's died yet because I screwed up. And to be honest I don't think I'd be able to post such a complication if it did happen. I guess that's the problem with medical writing, especially when speaking from a resident's point of view. Next year I'll probably more likely than not violate work hours, be involved in cases where devastating complications occur, and maybe even get to a point where I'm given enough responsibility to cause some of my own. But these are probably the things not written in this blog. How do we report that to the general public and expect them to understand, rather than litigiously hunt our heads? But make no mistake, for the most part in our profession, the patients that come our way would die without our intervention. Brain tumors, intracerebral aneurysms, intracranial bleeds and abscesses... these are dead men walking, their fates already written without neurosurgical intervention. But maybe this line of thinking is to justify my own existence and absolve my mistakes... we'll see.
I've heard the stories (none of these from UCLA btw): elective spine cases where one wrong slip leads to quadriplegia in an otherwise healthy gentleman; plunging into the aorta in a lumbar fusion case causing the patient to bleed out on the table; taking too much tissue in a epilepsy case that results in hemiparesis - these are the catastrophes one never thinks will happen to him, but invariably WILL happen if you're in practice long enough. In poker they say you don't always remember all your great wins, but you definitely remember the terrible losses, the bad beats, the hands that leave your pockets empty and hearts cavernous as you get up to leave the table. It's only natural for surgeons, at least the good ones, to remember the tragedies, as they're hopefully few and far between.
After being an intern in the hospital for a year, sure, I've seen people die, often in front of my own eyes. Good people, healthy people, the ones you expected to walk out of the hospital the next day. But no one's died yet because I screwed up. And to be honest I don't think I'd be able to post such a complication if it did happen. I guess that's the problem with medical writing, especially when speaking from a resident's point of view. Next year I'll probably more likely than not violate work hours, be involved in cases where devastating complications occur, and maybe even get to a point where I'm given enough responsibility to cause some of my own. But these are probably the things not written in this blog. How do we report that to the general public and expect them to understand, rather than litigiously hunt our heads? But make no mistake, for the most part in our profession, the patients that come our way would die without our intervention. Brain tumors, intracerebral aneurysms, intracranial bleeds and abscesses... these are dead men walking, their fates already written without neurosurgical intervention. But maybe this line of thinking is to justify my own existence and absolve my mistakes... we'll see.
Sunday, May 30, 2010
Not so lazy Sundays...
Days off during residency are bittersweet at best. It's nice being able to sleep through till morning, awaking to the sun rather than the leftovers of the passing night. On my days off it usually takes me an additional 3 hours to get out of bed. Not because I'm fatigued to the point where 8 hours of sleep isn't enough, but more because upon awaking I remember that the only thing that awaits me is more neurosurgery reading or paper writing. We're always instructed that our days off should be the time we catch up on our anatomy, write papers for journal publication, and continue our research projects. Exercise is a good idea, not for overall general health, but more so we can develop the stamina to get us through the long operative cases.
Yesterday I woke up at 10AM, all rested from the night before, ready to take on the new day. I got up, turned on my computer, saw the list of things to do for the day, turned off my computer, threw myself back into bed and went back to sleep. I woke at 1PM. OK fine, that's enough. I was still in a post-post call daze/depression, as I personally take on a rather dampened affect when I'm fatigued, so the rest of the day wasn't too productive.
I awake today (9AM mind you, not at the time of this post) reinvigorated, ready to take on the cruel peer reviewer comments of this paper I'm revising. Seven different sets of comments, each asking different things and expecting different degrees of crazy. What happened to the good old Sundays when we could lounge and read the comics after a nice family meal? There's no rest for the weary... careers in radiology are looking pretty good right now...
Yesterday I woke up at 10AM, all rested from the night before, ready to take on the new day. I got up, turned on my computer, saw the list of things to do for the day, turned off my computer, threw myself back into bed and went back to sleep. I woke at 1PM. OK fine, that's enough. I was still in a post-post call daze/depression, as I personally take on a rather dampened affect when I'm fatigued, so the rest of the day wasn't too productive.
I awake today (9AM mind you, not at the time of this post) reinvigorated, ready to take on the cruel peer reviewer comments of this paper I'm revising. Seven different sets of comments, each asking different things and expecting different degrees of crazy. What happened to the good old Sundays when we could lounge and read the comics after a nice family meal? There's no rest for the weary... careers in radiology are looking pretty good right now...
Monday, May 24, 2010
Egoism makes you bleed...
GAH, what a frustrating day.
At some time during your residency you start to get more comfortable with your everyday tasks and procedures. First it's the little things such as presenting vitals and physical exams on rounds (no, medical school really doesn't prepare you for everything). Then it's smaller procedures such as drawing CSF, starting arterial lines... then before you know it you're throwing in central venous catheters and ventricular catheters (that yes, go into the brain), like it was tying your shoes. Well, admittedly I don't believe I'm quite at the point where I can do an EVD (external ventricular drain - entails drilling a hole into a patient's skull at bedside and placing a catheter, more or less blindly using anatomic landmarks, into his brain, aiming for the ventricles, in order to drain cerebrospinal fluid [CSF] in the setting of increased intracranial pressure from bleeding, tumors, etc) like I tie my shoes, but I've gotten fairly adept at it. But this isn't about the advanced techniques, but rather the simpler ones we become overconfident in.
I was setting up to place an arterial line today, and as my last few had gone swimmingly, so I told the family I'd be done in 20 minutes. "Twenty minutes?" the nurse asked. "Yes," I responded, "no problem." It wasn't really due to arrogance, but maybe there was some underlying overconfidence there. Well in any case you can probably see where this is going. The line placement was a disaster. The patient kept flexing his wrists and arm like he was arm wrestling me despite the local anesthetic, boluses of propofol, and IV morphine and versed we gave him. I even achieved arterial flow, but his clonic movements made it impossible to thread the guide wire. At this point I should have stopped, but my claim that I could do it in 20 minutes (and the goading of the timer on the wall... cursed competitiveness) drove me on. His arm started looking like a pin cushion. Just as I was about to call it quits, my patient got his vengeance and curiously the needle turned in my hand and stabbed my other hand as I was trying to put it away. Did it break skin? No I don't think so... but then there it was, the faint tint of blood with the wrong color... the color of it being on the inside of the powdered latex. GAH.
I broke scrub (got out of sterile attire) and washed my hands. You win sir, this time. We sent the routine labs for HIV, Hep C, Hep B... I'm not too anxious as his family denied him having any history of these diseases, but I'm still somewhat apprehensive. It was a hollow needle, with a large bore: the kind of needle that has a greater chance of ruining your life.
Moral of the story: don't get cocky. Arrogance leads to bloodshed... and not infrequently your own.
At some time during your residency you start to get more comfortable with your everyday tasks and procedures. First it's the little things such as presenting vitals and physical exams on rounds (no, medical school really doesn't prepare you for everything). Then it's smaller procedures such as drawing CSF, starting arterial lines... then before you know it you're throwing in central venous catheters and ventricular catheters (that yes, go into the brain), like it was tying your shoes. Well, admittedly I don't believe I'm quite at the point where I can do an EVD (external ventricular drain - entails drilling a hole into a patient's skull at bedside and placing a catheter, more or less blindly using anatomic landmarks, into his brain, aiming for the ventricles, in order to drain cerebrospinal fluid [CSF] in the setting of increased intracranial pressure from bleeding, tumors, etc) like I tie my shoes, but I've gotten fairly adept at it. But this isn't about the advanced techniques, but rather the simpler ones we become overconfident in.
I was setting up to place an arterial line today, and as my last few had gone swimmingly, so I told the family I'd be done in 20 minutes. "Twenty minutes?" the nurse asked. "Yes," I responded, "no problem." It wasn't really due to arrogance, but maybe there was some underlying overconfidence there. Well in any case you can probably see where this is going. The line placement was a disaster. The patient kept flexing his wrists and arm like he was arm wrestling me despite the local anesthetic, boluses of propofol, and IV morphine and versed we gave him. I even achieved arterial flow, but his clonic movements made it impossible to thread the guide wire. At this point I should have stopped, but my claim that I could do it in 20 minutes (and the goading of the timer on the wall... cursed competitiveness) drove me on. His arm started looking like a pin cushion. Just as I was about to call it quits, my patient got his vengeance and curiously the needle turned in my hand and stabbed my other hand as I was trying to put it away. Did it break skin? No I don't think so... but then there it was, the faint tint of blood with the wrong color... the color of it being on the inside of the powdered latex. GAH.
I broke scrub (got out of sterile attire) and washed my hands. You win sir, this time. We sent the routine labs for HIV, Hep C, Hep B... I'm not too anxious as his family denied him having any history of these diseases, but I'm still somewhat apprehensive. It was a hollow needle, with a large bore: the kind of needle that has a greater chance of ruining your life.
Moral of the story: don't get cocky. Arrogance leads to bloodshed... and not infrequently your own.
Friday, May 07, 2010
Another manic holiday
You have to be a little manic to be a neurosurgeon. Occasionally, we must eat delusions of grandeur for dessert and use flight of ideas as our condiments to be able to deal with the sleep deprivation and high expectations. Cinco de Mayo this year was definitely one of those times. Crazy partying down in Hermosa Beach, driving home at 3:30 in the morning and waking up in an hour and change to get to work by 5:30. Then operating all day. Man. What a rush though. I was doing out patient procedures with just the attending and he let me do most of the cases as they were pretty simple. Changing batteries on deep brain stimulator generators, localizing nerve roots using fluoroscopy for radiofrequency ablations. Awesome times. The best part of working with an attending surgeon is that if you earn their trust during the earlier parts of the operation, they'll just leave the room and let you finish up once the "critical parts" of the operation are done. It's fun being "the surgeon" in the room, sewing things up, making sure the patient wakes up, and taking him to recovery. Suffice it to say I was in dire need of some operative cases. When you're cutting and slicing up the insides of someone's skull or body, sleep is definitely a distant thought... at least for now. I'm sure one day it'll become commonplace and I'll pass out on the operating table just like I do everywhere else (I swear I have narcolepsy).
Friday, April 30, 2010
Another head bleed
Last night was my first time taking R2 call for neurosurgery, and incidentally one of the busiest nights for neurosurgery in a while. It's nice to hear the ER attendings muse "I've been here for 17 years, and I don't think I've ever seen neurosurgery get hit this hard."
Fan-frickin-tastic.
It starts with morning rounds at 0515. Head CTs and MRIs from the night before, followed by rounding on the service's 35 patients (we're light right now). ICU rounds, battling it out with the neurocritical care team regarding what we think is the best care for the patient. Then a casual breakfast in the otherwise chaotic day at 0700, followed by phone calls to the attending neurosurgeons giving them updates on their patients. This is probably the most stressful part of the day. You never know what they're going to ask you about their patients, making it seemingly impossible to have the right information ready for them. Lots of "uh..." "one second sir...".
And then it starts. A young girl with leukemia who bleeds into her brain. A devastating hemorrhage that's left her unresponsive and intubated. But we can give her a chance. Set up the OR, consult pediatric hematology, hang blood products to correct her platelets of 25 and crit of 12. Oh yea, and who has a white count in the 300s? Honestly. While the blood products are running and hemapharesis going to correct her leucocytosis I steal off to grab a bite to eat. It's lunch at 1400, not too bad. I sit down to a nice piece of salmon and corn bread, yum. Phone rings.
Me: "Yes Dr. xxxx? Products are running and hemapharesis going. Well I don't believe we can do that in the OR. No I'm not completely sure. Yes sir."
Dr. X: "Your patient is dying, go go go!"
I got one bite of my salmon, and in trying to save my soda for the road, watched it explode on the cafeteria floor. It would have been more tragic had I known the next time I'd get a chance to eat would be 0330 the next day.
Push blood products. Deliberate best course of action. Coordinate OR time with hemapharesis. Rush patient to the OR. Pager rings: code trauma. Another CT scan, another head bleed. As the first case finishes up we wheel the next one through. 4 consults pending in the ED. Head bleed, head bleed, head fracture with head bleed, new brain mass... Phone calls from transfer centers asking to send patients with ventriculoperitoneal (VP) shunt malfunctions. Another consult: 90 year old Chinese male with ... head bleed. Hey, does anyone speak Chinese???
32 hours, two back to back red-lines, 11 consults, 0 sleep. I signed up for this? Stupid stupid stupid...
Fan-frickin-tastic.
It starts with morning rounds at 0515. Head CTs and MRIs from the night before, followed by rounding on the service's 35 patients (we're light right now). ICU rounds, battling it out with the neurocritical care team regarding what we think is the best care for the patient. Then a casual breakfast in the otherwise chaotic day at 0700, followed by phone calls to the attending neurosurgeons giving them updates on their patients. This is probably the most stressful part of the day. You never know what they're going to ask you about their patients, making it seemingly impossible to have the right information ready for them. Lots of "uh..." "one second sir...".
And then it starts. A young girl with leukemia who bleeds into her brain. A devastating hemorrhage that's left her unresponsive and intubated. But we can give her a chance. Set up the OR, consult pediatric hematology, hang blood products to correct her platelets of 25 and crit of 12. Oh yea, and who has a white count in the 300s? Honestly. While the blood products are running and hemapharesis going to correct her leucocytosis I steal off to grab a bite to eat. It's lunch at 1400, not too bad. I sit down to a nice piece of salmon and corn bread, yum. Phone rings.
Me: "Yes Dr. xxxx? Products are running and hemapharesis going. Well I don't believe we can do that in the OR. No I'm not completely sure. Yes sir."
Dr. X: "Your patient is dying, go go go!"
I got one bite of my salmon, and in trying to save my soda for the road, watched it explode on the cafeteria floor. It would have been more tragic had I known the next time I'd get a chance to eat would be 0330 the next day.
Push blood products. Deliberate best course of action. Coordinate OR time with hemapharesis. Rush patient to the OR. Pager rings: code trauma. Another CT scan, another head bleed. As the first case finishes up we wheel the next one through. 4 consults pending in the ED. Head bleed, head bleed, head fracture with head bleed, new brain mass... Phone calls from transfer centers asking to send patients with ventriculoperitoneal (VP) shunt malfunctions. Another consult: 90 year old Chinese male with ... head bleed. Hey, does anyone speak Chinese???
32 hours, two back to back red-lines, 11 consults, 0 sleep. I signed up for this? Stupid stupid stupid...
Monday, April 26, 2010
No more Mr. Nice Guy
I'm not sure about other programs, but they say your R2 year (second year of residency) of UCLA neurosurgery changes you. The neurology residents currently have bets going to see if I'll "stay nice" after the next year is over. The junior residents put their money on the persistence of good nature, saying I'll stay the same despite calamity and circumstance... but the senior residents know better. They've seen the lot of residents that come in smiling, charming, joking in common camaraderie, turn sour as the Q3 call (30 hour call every third night) and hail storms of consults (just last week the neurosurgery R2 got 7 consults in one hour) pulverize the softness of human civility and forge, out of necessity, the machine-like unfeeling neurosurgery junior. As if a surgical residency wasn't hard enough, now I have to be cognizant of staying humane while going through it? I don't promise anything, but I hope to write in this blog daily as this experience unfolds, so that if in 400 days the warm, young hearted boyish charm (^^) in my words degrades into the binary outputs of the terminator they expect me to become... somewhere, somehow, the slow transformation from man to machine will be documented and understood, and I'll be vindicated.
I'm getting temporarily promoted to R2 this Thursday and taking in house call. We'll see how it goes.
I'm getting temporarily promoted to R2 this Thursday and taking in house call. We'll see how it goes.
Saturday, April 24, 2010
Inspiration Remembered
During one of my neurosurgery away rotations I was honored to have worked with Dr. Alfredo Quinones. This man has the energy of a hamster on speed and the perseverance of a monkey trying to open a plastic banana. Of particular interest, is the tale when he hopped over the United States-Mexican border to illegally escape into the land of honey and opportunity. He was caught the first time and sent back; hardly enough to stop this man. He attempted again, obtained an education, trained in neurosurgery at UCSF, and now is an attending neurosurgeon at the prestigious Johns Hopkins University (I believe he's legalized now, so don't call the INS). One of the few things I'd taken away from the rotation at JHU, aside from a trip to the ER after being plowed by a 2003 Yukon (crazy Baltimorans), was him sitting me down and telling me that in order to succeed in life, one needs to surround himself with brilliant people. Reminiscent of an old Spanish adage 'digame con quien tu andes, y yo te digo quien tu eres' (tell me who you walk with, and i'll tell you who you are), I've found these words to be increasingly more true.
Saving the World:
A good part of the medical community I believe, or would like to believe, for at least a few seconds in their life had dreams of saving the world: eliminating poverty, achieving world peace, delivering chicken nuggets to everyone on Wednesdays. Small people, big aspirations. But the world teaches us that when we grow up, we are no longer children, and we put off our childish thinking and infantile delusions. There is no world they say, only isolated islands of capitalism, communism, and forsaken third world-ers somewhere at the bottom of the ladder. The hooing and hawing of politics and international policy drain the drive of the inspired, entangling them in logistics and law until they hang themselves in their vain efforts to break free of the system. But then there are others that in their Neo-like genius realize that the system can be bent, and even broken. There is no spoon.
I once believed that such people were truly rarities, the ones that you never meet, but only read of in books and epitaphs. But I recently met someone that really gave my matrix a run for its money. She wasn't born into royalty like Princess Diana, or birthed from the fires of political unrest like Gandhi. Nor was she a nun like Mother Teresa or a rock star like Bono. But in her own small ways, she was affecting change in rural countries, improving the lives of others in our own, and dreaming of ways to take these things to bigger scales in the future. As you know, I'm rarely one that gives compliments or openly admires people; but I was was thoroughly stricken with her life attitude, and probably came off as a blathering groupie. Not so much because she could change the world, but that she was doing so now. I always thought I'd have to grow up, be in a position of power to bring such change, but no, she was doing it now, yesterday, before she even graduated college. So yes, she deserved such praise.
Changing the world, one life at a time:
Then there are others who've devoted their lives to the pursuit of saving individual lives. We in the United Sates are in an age of science and technology where we can spend hundreds of thousands of dollars with the most sophisticated methods to save, and maybe not even save but prolong, the life of one person. Meanwhile the people of Malawi are dying by the tens of thousands for want of $1 a day supply of medication. I do not mean to excuse the latter egregious crime of our modern world, but mention the dichotomy to highlight how privileged we really are. We've come so far from the days where the lack of food, clean drinking water, or simple medical remedies would decimate towns in one untoward year. Now we focus on curing the ailments of those who've lived too long - osteoporosis, dementia, cancer, and other conditions where our exhausted topoisomerases give in to the calling graves below. Of these, perhaps one of the most specialized, smallest niche occupying, is the neurosurgeon. One in particular that inspires me is a friend of mine. His tireless pursuit to become the best, to eliminate the world's need for people like himself by curing the disease he treats, and inspiring the generations below to follow his lead - he definitely gives me something to work towards and aspire to be.
So the moments of inspiration are definitely there. They're in the people that happen to walk a path different from the ones laden with the mundane and trite technicalities of the world. They're in the roads that they forge, the roads less traveled as Frost said, and it makes all the difference. As the world saver said, it's about creating value from nothing; these friends are artists of humanity, in their ability to bridge people and create cures that did not exist before. They say the artist fears the blank canvas, and I'll admit to such fear. Fear that the brush strokes of my next 20 years will culminate in the scribblings of a six year old rather than the Monet I had envisioned. But to allow such fear to blind us would only hide the paths of change that my two friends walk. So thus I take the first strokes, and hope that their steps will guide the rest.
Saving the World:
A good part of the medical community I believe, or would like to believe, for at least a few seconds in their life had dreams of saving the world: eliminating poverty, achieving world peace, delivering chicken nuggets to everyone on Wednesdays. Small people, big aspirations. But the world teaches us that when we grow up, we are no longer children, and we put off our childish thinking and infantile delusions. There is no world they say, only isolated islands of capitalism, communism, and forsaken third world-ers somewhere at the bottom of the ladder. The hooing and hawing of politics and international policy drain the drive of the inspired, entangling them in logistics and law until they hang themselves in their vain efforts to break free of the system. But then there are others that in their Neo-like genius realize that the system can be bent, and even broken. There is no spoon.
I once believed that such people were truly rarities, the ones that you never meet, but only read of in books and epitaphs. But I recently met someone that really gave my matrix a run for its money. She wasn't born into royalty like Princess Diana, or birthed from the fires of political unrest like Gandhi. Nor was she a nun like Mother Teresa or a rock star like Bono. But in her own small ways, she was affecting change in rural countries, improving the lives of others in our own, and dreaming of ways to take these things to bigger scales in the future. As you know, I'm rarely one that gives compliments or openly admires people; but I was was thoroughly stricken with her life attitude, and probably came off as a blathering groupie. Not so much because she could change the world, but that she was doing so now. I always thought I'd have to grow up, be in a position of power to bring such change, but no, she was doing it now, yesterday, before she even graduated college. So yes, she deserved such praise.
Changing the world, one life at a time:
Then there are others who've devoted their lives to the pursuit of saving individual lives. We in the United Sates are in an age of science and technology where we can spend hundreds of thousands of dollars with the most sophisticated methods to save, and maybe not even save but prolong, the life of one person. Meanwhile the people of Malawi are dying by the tens of thousands for want of $1 a day supply of medication. I do not mean to excuse the latter egregious crime of our modern world, but mention the dichotomy to highlight how privileged we really are. We've come so far from the days where the lack of food, clean drinking water, or simple medical remedies would decimate towns in one untoward year. Now we focus on curing the ailments of those who've lived too long - osteoporosis, dementia, cancer, and other conditions where our exhausted topoisomerases give in to the calling graves below. Of these, perhaps one of the most specialized, smallest niche occupying, is the neurosurgeon. One in particular that inspires me is a friend of mine. His tireless pursuit to become the best, to eliminate the world's need for people like himself by curing the disease he treats, and inspiring the generations below to follow his lead - he definitely gives me something to work towards and aspire to be.
So the moments of inspiration are definitely there. They're in the people that happen to walk a path different from the ones laden with the mundane and trite technicalities of the world. They're in the roads that they forge, the roads less traveled as Frost said, and it makes all the difference. As the world saver said, it's about creating value from nothing; these friends are artists of humanity, in their ability to bridge people and create cures that did not exist before. They say the artist fears the blank canvas, and I'll admit to such fear. Fear that the brush strokes of my next 20 years will culminate in the scribblings of a six year old rather than the Monet I had envisioned. But to allow such fear to blind us would only hide the paths of change that my two friends walk. So thus I take the first strokes, and hope that their steps will guide the rest.
Monday, February 01, 2010
Moments of Inspiration
The monotony of intern year is not without its moments. Moments of reflection, moments of fatigue. Moments that take your breath and others that give you life. But the monotony of intern year is usually without these moments in its monotony. The shrill alarm that ends the peace found in the passing near death state we so learn to love, reminding us that we are to rejoin the world of the living, the suffering - the not dead. Early morning rounds. Moments of "crap, I forgot..." and others of "Yea, I'm smart, I know." But even self complimenting gets old. Orders, orders, orders. Follow up this, follow up that. "Patient's family is in the room." "But he said he'll go down for the study if you give him IV dilaudid."Day in. Day out. And nights in between. But these moments, oh these rare moments, when one sees the glimmer of life in the sea of repetition and death.
What were they...
I don't remember...
And the incessant pages go on. The late night admissions leave shards in the once tranquil tapestry of thoughts. And we forget the rare moments as the not so rare, the constant, the incessant, the flooding of uninspiring feculence flushes us back into waking realism.
Maybe they weren't so great.
Waste: A 15 year old boy, so much life ahead. Dead now. Found face down in a splay of syringes. Thirty-four weeks I carried him. He cried after his first shot; so different now with his pin cushion arms. Such a damn waste of life. His life must mean something. A liver. Two kidneys. Three meters of small bowel. Three lives saved out of tragedy.
What were they...
I don't remember...
And the incessant pages go on. The late night admissions leave shards in the once tranquil tapestry of thoughts. And we forget the rare moments as the not so rare, the constant, the incessant, the flooding of uninspiring feculence flushes us back into waking realism.
Maybe they weren't so great.
Waste: A 15 year old boy, so much life ahead. Dead now. Found face down in a splay of syringes. Thirty-four weeks I carried him. He cried after his first shot; so different now with his pin cushion arms. Such a damn waste of life. His life must mean something. A liver. Two kidneys. Three meters of small bowel. Three lives saved out of tragedy.
Thursday, December 10, 2009
Ironic Medicine
I was told today that I must be a good doctor because I looked so tired.
I can't help but feel sometimes that my choice of profession is somewhat sick. The countless hours spent in the hospital is a stark reminder of how precious life is, how every ephemeral moment should be treasured. And yet it seems that the ones that are living the lessons I'm learning are the ones that haven't learnt said lessons at all. And me who keeps learning the lessons they're living, will keep learning and not living so that they may live instead.
A moment of today, all of my yesterdays, for one more tomorrow.
I can't help but feel sometimes that my choice of profession is somewhat sick. The countless hours spent in the hospital is a stark reminder of how precious life is, how every ephemeral moment should be treasured. And yet it seems that the ones that are living the lessons I'm learning are the ones that haven't learnt said lessons at all. And me who keeps learning the lessons they're living, will keep learning and not living so that they may live instead.
A moment of today, all of my yesterdays, for one more tomorrow.
Monday, March 26, 2007
consumed
And in hate he was consumed,
until there was nothing beyond nothing,
of why he was.
Void of everything,
in the infinite shades of a man's heart,
infinite, only as time would make him,
cold, only as time would leave him.
until there was nothing beyond nothing,
of why he was.
Void of everything,
in the infinite shades of a man's heart,
infinite, only as time would make him,
cold, only as time would leave him.
Monday, February 26, 2007
The making of a coffee table
As with all great stories, this one begins with one of the cardinal sins of man. Though I fear to disappoint, and rest assured I bear with my own disappointment that this story does not detail one of the racier vices of lust or grand theft, this tale sparks its birth from the green seeds of envy. But not just any envy, dear readers, no. It was envy of a 30” Toshiba flat screen HDTV with a 5.1 channel digital surround sound Boss speaker set and an XBOX 360. He obtained these items in a shopping spiral to adorn the barren void of our common room, but in doing so inadvertently mocked my nascent sense of electronic gadget ego found in countless college aged Korean men. When I moved out into my own apartment, I decided, no, I pledged that I would have an entertainment system to rival that which I had seen.
The pride of the Korean male coursing through my body fueled my search for the ultimate TV. However, it also fed my necessity to find the best possible deal on this new addition to my life… and thus my search on craigslist began. After weeks of searching and emailing I found the TV I wanted. It was a 30” Sony HDTV WEGA, editors choice in 2004 for best picture quality and bang for its buck. Beautiful. I met with Dave, who later revealed himself to be a CEO for a porn industry in
The TV thus sat, and many of you have seen what a lovely side table it has made over the months. My backpacks and jackets had grown fond of being carelessly thrown upon the electronic shell of what was a masterful tantalizing piece of audio video heaven. However, the bulky corpse, I found was too much for my apartment to accommodate, and thus began the making of a coffee table.
The project was simple, the front glass plate would make an excellent table top. Take out the tube, take the front plate, chuck the rest. No problem.
Unscrew, unscrew…
The front plate is actually a part of the picture tube…
Big problem.
Hatchet.
Problem solved.
I then ensued to smash away the glass from the posterior aspect of the picture tube (for those who can’t visualize what it looked like previous to my Last of the Mohicans’s moment, see figure 1). Shards of glass flew everywhere, but despite the adrenaline and terror, I threw my faith to my Rubbermaid dish gloves and make-shift surgical mask of toilet paper and continued. Actually the mask only came after I realized that I was pulverizing the glass and aerosolizing it… probably the 3rd scariest thing I’ve done in my life. I taped up the bottom ends of the cut surface to don the guise of safety, and the top was complete. Too low for a coffee table, though. Hey, the frame has circular holes in it. HEY, the ikea lamp poles fit PERFECTLY into them. After much research online, I found that the lamp poles would be fit by a 19/6 – 18 TPI bolt… yea. Good thing Home Depot has everything.
Final product~
And they said it couldn’t be done…
Tuesday, August 08, 2006
holding breaths
Every moment we are alive, we are living. A trite statement of rhetoric, perhaps, but one whose simplicity it took me 24 years to understand. A being of goal oriented thinking, I spent my entire life wondering when I would finally be able to live, as if years of education and training were merely preparation for a future of luxury, of contentment, of "life". Fool. As if the future - which with its counterpart, past, do not exist, as one is merely an idea of events yet to happen, while the other is the scent of events that already were - were something special. As if these delusions of grandeur could really be more incredible than the oxygen that flows through my blood, giving life with each breath; more great than the calm morning wind that caresses the core of my being as I walk tranquil streets. A phantom of things to come, the potential of things that are not, more real or wonderful than the simple majesty of things that are? Impossible. Yet just as difficult to see. Those that hold their breath, waiting for tomorrow, not pausing to inhale the fragrance of roses, will die waiting, as tomorrow never comes. The tragedy of life is not that we must die, but that we wait to live.
Monday, May 29, 2006
Trauma Surgery Rounds at Harbor
I shadowed the trauma team at Harbor UCLA hospital today.
There was a man who was brought in naked, just the way he was when he jumped (or maybe fell) off the third story balcony of his home, blue pills scattered all over the place. He had multiple fractures throughout his body: left humerus, right pubic symphisis, transverse spinous processes. He had slit his wrist somehow before he left his loft, yet despite all this was amazingly still alive. His perineal bleeding led to his scrotum swelling up to the size of his thigh (i kid you not); I wonder if he thought he was more of a man for this. He crashed while waiting for the interventional radiologists, who were the only lazy bastards in the hospital that couldn't be found - 20 minutes of this man's life added to their already inflated paychecks. A thoracotomy was performed, and the trauma surgeon manually pumped John Doe's heart with the accuracy of any good SA node. I watched Doe's left lung inflate and deflate, inflate and deflate, into the open air of the OR. He flatlines. No good. No pulse. Intrathoracic defibrillators. Still nothing. Ok, wait. A heartbeat. Radiologists continued looking for the ruptured vessels to stop the incessant bleeding. Need more blood. The blood bank says they're running out. Tell them to call the Red Cross. More blood. More plasma. They drip the life of others into him as it drips back out as his own onto the OR floor. He flatlines. Time of death, 21:55. 16 units of blood, 12 units of plasma, transferred from life saving bags to the OR floor and his scrotum. Police say he had been drinking heavily while abusing antidepressants for the past week. He didn't want to live anyway. With slit wrists, blue pills, and a third story balcony, what right did we have to try and save him?
There was a man who was brought in naked, just the way he was when he jumped (or maybe fell) off the third story balcony of his home, blue pills scattered all over the place. He had multiple fractures throughout his body: left humerus, right pubic symphisis, transverse spinous processes. He had slit his wrist somehow before he left his loft, yet despite all this was amazingly still alive. His perineal bleeding led to his scrotum swelling up to the size of his thigh (i kid you not); I wonder if he thought he was more of a man for this. He crashed while waiting for the interventional radiologists, who were the only lazy bastards in the hospital that couldn't be found - 20 minutes of this man's life added to their already inflated paychecks. A thoracotomy was performed, and the trauma surgeon manually pumped John Doe's heart with the accuracy of any good SA node. I watched Doe's left lung inflate and deflate, inflate and deflate, into the open air of the OR. He flatlines. No good. No pulse. Intrathoracic defibrillators. Still nothing. Ok, wait. A heartbeat. Radiologists continued looking for the ruptured vessels to stop the incessant bleeding. Need more blood. The blood bank says they're running out. Tell them to call the Red Cross. More blood. More plasma. They drip the life of others into him as it drips back out as his own onto the OR floor. He flatlines. Time of death, 21:55. 16 units of blood, 12 units of plasma, transferred from life saving bags to the OR floor and his scrotum. Police say he had been drinking heavily while abusing antidepressants for the past week. He didn't want to live anyway. With slit wrists, blue pills, and a third story balcony, what right did we have to try and save him?
Wednesday, March 22, 2006
swept away
A great mind once spoke of taking a road less traveled. The footsteps along a path of consequence, forged in the heat of passion; a passion for living, a passion for believing, a passion for dreams. I too have embarked on such a path, but feel as if I am being swept by the tides and eddies of consequence, into a depth I do not comprehend nor wish to fathom in fear of my own mortality, my own humanity, the smallness of my being that nurtures a flame of purpose, or a search thereof, within the human soul. Though this vessel is small, and powerless against these tides, I shall keep it sailing with pride as the waters of misfortune wash me to the directionless depths of mediocrity.
Monday, March 06, 2006
I am water... flow with me baby.
You are water. You're not really organic; you're
neither acidic nor basic, yet you're an acid
and a base at the same time. You're strong
willed and opinionated, but relaxed and ready
to flow. So while you often seem worthless,
without you, everything would just not work.
People should definitely drink more of you
every day.
Which Biological Molecule Are You?
brought to you by Quizilla
Subscribe to:
Posts (Atom)
