Wenckebach. Winston. What time is it?

This week marked my first week in the Cardiac Care Unit (CCU). This is where I'll be spending my last four weeks of my rotation. I'm here with Erin, Joanne, and a girl here for a Cardio elective, Aditi (she's South African). There are no call shifts and you're often done early, which is awesome because I have more time to study for the shelf exam. It's nice to be off the floors and focus on a specific part of medicine. I've always enjoyed cardiology in class for the first 2 years of med school, so this should be good. We're also being mentored more directly by an attending as opposed to a resident or interns. Our attending is near retirement and has a wealth of information, which is great. In addition to the attending, there is a Cardio fellow, an IM resident, and an IM intern. I haven't heard great things about our resident and intern, but I don't have to work with them very much which is a good thing according to the people who warn me about them.

The CCU has 6 beds with a 2 patients:1 nurse ratio. I'm not sure what it's typically like in a CCU, but for this week, it's been a 50:50 situation with our patients in terms of condition. Half get better and eventually get discharged. Half don't get better and are either kept alive by machines or have passed on. Aside from following those 6 patients, we also spend some time on the floors for cardiology consults requested by internal med teams that I used to work on in the last two months. So I'm not completely removed from the floor world. That's pretty much all there is to say about work. A lot of MOTS.

It's been a while since I've talked about music, so here's a little update. Since I don't have any musical instruments nearby, I've been checking out new music quite a bit. I probably average a new album every other week. What have I purchased lately? I bought Hillsong's latest "No Other Name", then U2 put out a new album for free on iTunes which was awesome, then I bought the original score to "Wish I Was Here" to go with the soundtrack I purchased back in July. On top of that, every week, I'll download iTunes free song of the week. Great way to find new music. 

Since I don't have TV, I usually watch clips on YouTube. The channels I subscribe to and check regularly on YouTube are the Canucks, the Tonight Show with Jimmy Fallon, the Ellen Show, Conan O'Brien, Last Week Tonight with John Oliver, Walk Off the Earth, and Movieclips Trailers. So basically I get my sports, some music, some movies, and a lot of laughter from YouTube. I will say that I enjoy John Oliver's channel the most because his pieces are so informative and hilarious. He hails from the Daily Show/Colbert Report genre of political humour, but it's quite frankly the best that's out there for free. I highly recommend checking him out.

In the last few weeks, I've been chatting with my new sister-in-law Naomi via WhatsApp (which is an app that is a blessing for me and my Canadian loved ones - no long distance fees). We never got to spend much time alone together. Most of our time was spent in group settings which definitely lets you know each other, but this private back and forth we've got going has been really enjoyable. We've talked about all kinds of things. 

Nayo and Gav recently adopted a dog during their honeymoon roadtrip in California. They named him Winston and he seems to be a very welcome addition to the family. He's a chill 1.5 year old cocker poodle who loves to cuddle and sleep. That was Nayo's sales pitch to me. She definitely knows what I value in a companion, I'll give her that. I'm not a dog person per se. I'll give them attention and love to an extent, but if they get too needy, I'm over it quickly. The Deutschs have Tika and Lily. They're both very loving dogs that greet you with such enthusiasm. Lily always licks my pants whenever I enter the house though and that's definitely not my favourite part of the day. Tika on the other hand loves being pet so much that she makes love moans/howls. It's cute for a second and then I'm done. I'll literally stop petting her because of it. She'll whimper for a few secs and then she knows the moment's over. Luna and Loki were two dogs that I spent a great deal of time with while living in Miami. They were very loving and quiet. They'd play with each other loudly though. I suppose that's what you should expect from a pitbull and a bulldog. Whenever Loki wanted attention he'd amble over to my chair and lie down beside me while I studied. Luna on the other hand would climb into my lap and interfere with my studying to ask for a scratch or give me a kiss. She'd get my attention for a few secs, hop down, and return later. If she returned too soon, I'd push her off. I'm telling ya, if you're too needy, I'm not interested. The only other dog that I have rapport with is the dog I call the little shit. Tucker is a yappy ball of fur who wears me down within seconds of entering the house. Being the "son" of Erin and Jesse, I technically have "auntie" privileges, but he's the nephew I conveniently choose to disown. I love Erin to pieces for many reasons, but Tucker is not one of them.

I'll meet Winston in December, but I've got a feeling he'll be the kind of dog that I can get along with just fine. I've seen many pictures of him cuddling with relatives or hanging out with other dogs no problem. While the pictures are cute, the most interesting fact I've heard so far is how gaga my parents are over him. They sound like different people when I hear about their interactions with Winston whenever he comes over for Sunday family dinners. Another thing I hear is how old people come up to them to admire Winston, which is freaking adorable. Since Winston is hypoallergenic and so chill with strangers, they're thinking of enrolling him in a dog visitation program for both children and the elderly, which I'm all for. It's a great story about a dog getting rescued from being put down, getting a new life minus the anxiety problems that come with other rescued dogs, and offering a bit of happiness and maybe even nostalgia for others who could really benefit from those moments. 

On a completely different note, check out this new invention on kickstarter. Court, this is like my chillow. Anybody who knows me, knows I love ice cream. While I take pride in my sculpted arms, as the video so accurately shows, they have little input in my wrist focused attempts to liberate that delicious frozen treat. I have to either let the ice cream thaw or run the scooper under hot water. This device will let me use my toned upper extremities so that I can enjoy sweet lactose heaven that much easier. If you are interested in backing this genius tool, you have 4 days left.

Tonight I had dinner with Erin, Joanne, her boyfriend, and another classmate Stephanie at Momofuku Noodle Bar where we made reservations for their fried chicken dinner special. Two chickens - one southern and the other Korean style. 4 sauces. A bowl of greens, fresh baby carrots and radishes. A plate of Korean wraps. Go nuts. 

FEAST!

 

Dinner was wonderful. The chicken was so tender and not greasy. We were there for a good two hours of eating and drinking merrily. After that, we walked around to pick up dessert at Spot, spontaneously pulled a quick hour of karaoke which was just two doors down (I sang Coldplay's "Yellow" and JT's "Sexyback"), then met up with Tamera and Hammad a few blocks away for hookah and mingling. 

 Definitely a full day and I am very tired as it is very late.

Goodbye Blue 1, Hello 28

Sunday's service had the Christian acoustic version of Mumford and Sons as our worship band. New York, you are so full of talent. Our senior pastor's mother suffered a stroke recently, so Tim Keller came in to give the message and continue the series on Matthew 11. I haven't read any of Tim's books, but if they're anything like how he preaches, then I'll probably check them out when I have the time. He's pretty funny. I love me some dry wit and he's got it down pat. I think of Gary Drouillard and Pop Deutsch whenever I witness excellence in dry humour. I'd say 50% of the effect is in the joke itself and the other 50% in the delivery. I'll be the first to admit that I laugh at my own jokes. Heck, I often laugh as I'm telling the punchline. But these guys, they get the punchline and the delivery all wrapped up in a nice hilarious package, without cracking up. And when you have someone like Caroline as your audience, it makes the joke that much sweeter. I can never not laugh when telling a joke in her presence. It's so perfect, you just want to join her in it. Anyways, Tim Keller's funny, but he's very compelling too.

This week was my last week on Blue 1. It also brought a new resident and intern to the team and boy did that make it a rough week. After a couple days, things really weren't getting done to the extent that they should be, and in the teaching medical world, crap rolls downhill until your reach the students (we're bulletproof because we're the ones paying to be there i.e. we're partly responsible for their paycheques). So the attending yells at the chief resident, the chief residents yell at the resident, and the resident yells at the interns. Wednesday, I left the hospital half an hour later than normal because my resident was ripping into the interns after sign-outs and then noticed that I was still around. So he dismissed me so he could continue tearing them new ones in private.

Most of the students in our rotation

I've been here two months now and I'm starting to discover what personalities are best suited for internal med, and quite frankly, the two interns I had on my team this week have personalities that are too soft. On the first call shift this week, the intern and I checked in on a patient. She's in her 40s and suffered an NSTEMI (a type of heart attack) and had questions about her diagnosis. She had recently seen her primary care physician and was given a clean bill of health. So she couldn't understand how it was possible to have cholesterol clogging up an important artery in her heart. My intern hesitantly explained to her the process of ischemia using a rolled up magazine as an artery and invisible cholesterol clumps placed with his fingers inside the magazine. She was not amused. She felt like she wasn't being heard. After rewording her question regarding her cholesterol levels, and being met with an explanation of how certain diets and lifestyles affect cholesterol levels in the blood from the intern, I excused myself. I ran to the nearest computer, looked up her lipid levels and brought the results back to her explaining that her total cholesterol, triglycerides, and LDLs were all within normal limits, but her HDL was markedly low. I told her about good cholesterol and bad cholesterol and that the ratio is important even if the bad cholesterol is textbook low. She thanked me then asked how long I'd been working at the hospital for and I told her since the end of July. Then she turned to my intern and said "Oh you must be newer than her then". In his defense, he only started a few weeks before I did. I still found it amusing though. Sometimes being Mr. Rogers isn't what your patients want. I may have overwhelmed her with too much medical information, but at least I'm giving her a direct answer instead of trying to baby her with an inadequate answer. The real task is being able to address what the patient wants to ask, not necessarily what they literally ask. Communication skills, guys, never underestimate their importance.

For my second call shift with the other intern, I was taking care of smaller things like checking to see if certain labs, imaging, or consults came back, while also making sure my intern wasn't wasting too much time doing something else like getting stuck in radiology to push IV contrast for patients. I was giving updates to the resident about what had been accomplished so far, notifying my intern of new orders that needed to be placed, and ensuring that those who were due for discharge were actually on their way out or gone. There's a lot of things going on and being on call on the floors in internal med means you have to multitask and be aware of all the balls in the air. If you lose track of something or fall behind, you're not doing well. Yes, it demands a lot and it's tough, but you have to take it and tackle it the best you can. You can't have a pity party and make excuses for yourself. Unfortunately that's what this intern does and it's not helping her cause with the resident, attendings, nurses, or techs. So far, I've worked with at least four interns like this and it makes me wonder if they'll stick with internal or choose a different residency.

Friday, after rounds, my attending asked to speak to me alone knowing it was my last day with her. She told me I've got the personality for internal medicine and that my confidence was a real asset. She asked if I was going to apply for residency there and I informed her that I was only a 3rd year and that I'm setting my sights for something in Canada first. All of which was a surprise to her, first that I wasn't a 4th year (who all just started their residency application process) and second that I was Canadian, "But you don't sound Canadian!". If I had a dollar for every time someone's said that to me, I'd have close to $100. Nonetheless, it was all wonderful to hear that from her, but my heart still leans toward Family Med.

Monday was my 28th birthday. I don't care much for my birthday, not because I'm getting older, but because I don't like the extra attention. I didn't tell anybody at work and I almost made it the whole day until Joanne managed to check Facebook shortly before sign outs. She's on a different team and floor so we didn't see each other, but she sent me a text and then another classmate confronted me in the hallway, shortly followed by one of my interns. Word traveled quickly, but within 30 minutes I was on my way home. My aunt and uncle sent me a birthday card a couple days early, but I saved it 'til my birthday to open. I received emails from my Deutsch parents, my Krause parents, my biological parents, the usual heart warmer from Court, the warm fuzzy notes from the other little sisters Mac and Bai, the standard messages from the brothers, and text from the new sister-in-law. Facebook is an interesting thing on your birthday because you spend so much time on it responding to all the birthday greetings sent your way. There are posts from random people and then there's those gems that you're reminded of how much you enjoy them in your life. You ended up smiling a lot at your computer screen. In classic fashion, I got a text just as I lay down in bed from none other than Chelsea Dean, who continues to forget the three-hour time difference between us. To her credit, the text asked if I was still awake so that she could call me. It wasn't long after I responded that I was listening to her giggling through the ear piece. Not gonna lie, hearing how loved you are from a dear friend is probably one of the best things to hear shortly before falling asleep. Whenever Erin and I had sleepovers (as kids or teens), we'd say "goodnight" to signal that we're done talking and are ready to sleep, then end it with "I love you" so that it's the last thing we say/hear before falling asleep. I highly recommend practicing it with your bed buddy.

Later in the week, I got mail from my grandparents and Deen & Jeff. Thanks to them, I have some more pics to decorate my desk in addition to the ones I travel with and some other ones I got printed while here. 

Surrounded by smiles and beautiful people

Today was round 2 at Smorgasburg with Joanne and Erin. Tamera joined us later on and then we met up with Travis and Hammad for drinks. We stuffed our bodies full of ramen burgers, spicy ahi tuna tacos, grilled cheese, lobster rolls, fried chicken and waffles, pasta, doughnuts, mini muffins, iced drinks, cocktails, beer, and milkshakes. To say my stomach is a little overwhelmed would be an understatement.

Feasting

Interactions

Sunday, I headed down to the Park Slope area of Brooklyn to meet up with my old Kwantlen friend, Amanda, for lunch. Amanda was in a group of friends from Kwantlen that all excelled. It's boasting, but seriously, our crew did well. Two pharmacists, one dentist, five soon-to-be MDs, and one BioChem PhD - 9 doctors in total, and that's just our group of friends. I have no doubt that others in our class of 30 went on to do equally amazing things. Just goes to show that any stigma attached to smaller colleges is completely unfounded. They put out students just as great, if not better than the big universities, and they're cheaper and have smaller class sizes for excellent teachers. If Kwantlen awarded B.Sc's in my field of interest when I was there, I would have done my degree there instead of transferring to UBC. 

Anyways, Amanda is in her 4th year of medicine who just finished taking Step 2. She went to St. George's University (another Caribbean school). She's done all her rotations in New York and will be doing some electives in the Tri-State area. She married an American in the military who has 10 years of duty left. So it's possible that she'll return to Vancouver in a decade, which would be wonderful. She's still the same smiley sarcastic girl I met 10 years ago, just more grown up. It was great catching up with her and sharing our thoughts on American medicine and supporting each others' opinions. She's leaning in the Pediatric direction. Either way, she'll be a great doctor.

I returned home and as soon as I entered the door, Judy said "I received a package from a friend and was wondering if you could figure out how to use it for me". I agreed to look at what it was and see what I could do. This is what I found waiting for me:

I don't know how familiar you are with this product, but it's freaky. The headphones give a series of tones accompanied with lights installed in the glasses to provide a certain "mood" that's supposed to address various needs - creativity, deep rest, energy, etc. I figured out how to use it and did not enjoy it. Neda seemed to enjoy watching me work though so at least someone was having fun.

I called Judy up and took her through the ropes. She was quite confused by the product. I set her up with a "relaxation" program to test out and she responded with "I feel very anxious" and I completely agreed.

After that, I headed to church where I clued in that the last Sunday I was there was the long weekend, because there were probably close to 350 people in attendance this Sunday. The worship team was equipped with a pianist, cellist, violinist, upright bassist and drummer. It was phenomenal and reminded me of Bailey and her recent dabbling in cello-related aweseomeness. Headed home in time to Skype with the parents, then squeeze in some studying before hitting the sack. 

This week brought Blue 1 new interns, both very capable. Despite that, we got dumped with a bunch of new admissions pushing us beyond the 20 patient/team cap. I'm not sure how it worked out that way but it made for a stressful and exhausting week. Despite being overloaded with patients, none of them coded which was great. The call-shifts went well too. 

There's a young nurse on the 10th floor who has taken a liking to me since I helped her out in my first week. I don't think she knows I'm just a student because she always addresses me as doctor and I've never had reason to say "I can't do that, I'm just the student". That first week when I helped her, she asked what my name was and I said "I'm Kirsten" and offered her a handshake. She was a bit surprised, took my hand and said "Nice to meet you", then briefly looked at my badge which coincidentally has "Yip" as my first name and "Kristen" as my last (that name is the bane of my Ross existence). She must have just read the first name because she said "Oh, I should probably call you Dr. Yip, but thanks doc". There's a bunch of speculation I could make as to why that interaction was important to her and I'm scared if the theory that new doctors/interns are too egotistical to personally introduce themselves to nurses is true. Regardless, whatever preconceived notions or misinterpretations she's made about me have all made for a rather successful working relationship for us. She was working nights this week so whenever I used the computers on the 10th floor nurses station during call-shift and one of her patients had something going on, she'd come to me first. Names are altered to protect identities.
"Doctor, do you have Ms. So-and-so?"
"What room is she in?"
"1002-B"
"Nope. Let me look up what team she's under. Pink 2. I think Dr. Whats-his-name is on call for Pink tonight."
"Oh, thanks doc!"
"My pleasure"
later on in the evening...
"Doctor, what colour are you?
"Blue" - on call shifts we cover both Blue 1 and Blue 2 patients
"Oh blue great! Mr. Something-or-other's pulse ox monitor is setting off periodic alarms for tachycardia and his wife is concerned. I checked it out and he seems fine, but she keeps asking for me when the alarm goes off. Do you mind going in to talk to her?" 
"Not at all." - educating someone about the heart is pretty fun for me
"Thanks doc"
the next call shift...
"Hey doctor, what colour are you tonight?"
"Blue"
"Just blue?" - residents cover two "colours" - blue and green, or yellow and pink. For her to ask if I cover another colour is putting me at least four years ahead of where I currently stand. I look up from the computer to make eye-contact
"What colour were you hoping for?"
"Haha, green, but don't worry, I can see that you're super hard at work" the last part said with sarcasm as she slowly walks away giggling
"You'll want Dr. Who'sit or Dr. What'sit instead!" half yelling in an equally sarcastic tone from my comfortable seated position in front of the computer
"Haha, of course. Thanks doc" without slowing her pace or turning around to face me, just with a wave of her arm
I might just miss her the most when my time is done here.

Plenty of other interesting interactions took place this week. One of my new interns told me that I have a personality suited for surgery, which can be either a compliment or a back-handed compliment. Apparently, it's because I "don't get flustered easily and have a matter of fact tone in certain situations", which could also be a euphemism for I "can be a stone cold bitch sometimes". I'll take it. During the same shift, I made a call on behalf of a patient to check on her daughter (she didn't pay to activate her room phone and couldn't walk to the nurses station). I spent 5 minutes updating the grandmother, then was passed o nto the 5 year old who was having a good day of playing with her friends and watching tv. The nice thing about talking to a toddler on the phone is that, they take the time to find their words while I take the time to review another patient's chest x-ray. Multi-tasking. As special as all these moments are, my favourite one has to be the end of Friday's shift. It was my last day with my resident before he moved onto a different assignment. He took the time to take me aside, thank me for the work I did on his team, and in giving me a firm handshake, told me that I "seriously have a lot of potential to be a great doctor". Now I suppose you could say that to anybody, but there was a level of sincerity (or perhaps gullibility on my part) that made me actually believe him.

Spending 9/11 in Brooklyn was an interesting experience. It was a day like no other, even though the work day was like any other. Everyone was nicer. A smile was given from every person I walked by or made eye-contact with on the subway. A gentleman told me "You're beautiful, baby". Ok maybe he'd be more of a gentleman if he just simply said "You're beautiful", but still it's better than "Damn girl, you fine" (which unfortunately, I have received). But seriously, people were being purposeful and intentional in showing kindness. It was really touching because we all don't know who has been hurt by the 9/11 attacks or how hard the day is. We just know that this is where it happened, and regardless of how long we've been here for, this is where we live. There's this sense that we owe it to those who have been affected to show that we are stronger and closer, that their loss is our loss and we appreciate how sacred life is, at least on that day. Our hospital announced a moment of silence at 8:46am (when the first plane struck the North Tower i.e. when we knew it would be a sad day, but had no idea how sad it would be). The woman's voice over the PA system ended the moment with "Thank you and God Bless America". She repeated it three times, much like she repeats code calls. It was a day I'll never forget.

The South Memorial Pool where the South Tower stood

 On the heels of that, I decided to visit the 9/11 Memorial and Museum today. I felt it was important for me to do that this weekend. So I headed down to Ground Zero and took it all in. The museum is just two years old and I highly recommend anyone who visits NYC to go there. I spent just over 2 hours there but could have easily spent twice that if I didn't have plans to meet up with Malini later. I even had to ask her to push our date a little later so I could have more time. It has a large exhibit that takes you through 9/11 chronologically with immense detail, quotes, recordings, etc. As you relive the reality of that day, it hits you hard. It's the only museum I've been in with kleenex dispensers scattered throughout and strangers comforting each other. There were some areas that I just couldn't stay in. Sometimes it was due to the content. Other times it was because witnessing another person's grief was too much for me to handle. There's a little hidden alcove in the exhibit that people easily pass by and once I went there, I knew it was designed that way on purpose. It was the area dedicated to those who jumped. Don't get me wrong, I think it's important that that section is part of the exhibit and they treat it respectfully, but it's tough to stomach. It brought me back to high school on that fateful day, when my friend Sheena got really broken up when they started showing the falling bodies on the news. Some of us were confused and didn't completely understand what was happening (we didn't have audio as we were watching through the upstairs windows of the library). I initially thought they fell because the structure was failing or they were trying to climb to a safer floor and lost their balance. But Sheena, she knew, and it crushed her. As I turned to leave the alcove, I saw a women with her eyes wide open, tears pouring down her face, jaw dropped, with her hands covering her mouth. It was as if she was Sheena. It was as if this was the first time she'd ever seen those images. Maybe it was. Regardless, she was paralyzed in her grief and two male companions helped her walk away from the area as I made my own escape. This event happened 13 years ago, but the wound is still fresh and open for plenty of people. Even though Bin Laden is dead, we'd be fools to think that that's any form of closure.  

The last column to be removed from Ground Zero

Each square represents an individual who died from the attacks

I'll go back one day so that I can see everything I missed today. Despite the sombre atmosphere, you also feel like you're someplace sacred knowing that hundreds of first responders lay down their lives here serving others. 

I took the subway to the Upper East Side to meet up with Malini for lunch at Luke's Lobster and dessert at Two Little Red Hens. It was nice to catch up with her and talk about our clinical experiences so far. Hard to believe that my time here is halfway done before I take off for Ohio. It's a big city here, but I've been trying to interact with it more and more each day. Little things like looking up when I'm on the subway or bus or walking instead of hiding in a textbook, my phone, or the ground. It's easier to see beauty and be thankful for it when I take the time to look around. Easier to see people and love them when I take the time to give them time. Sometimes it's that simple.

Count, consider, choose

I have finally found the church I'll be attending while in New York. I've gone to a different church for the past few Sundays in search of the one that I feel most "at home" in. The first week doesn't really count because I went to Brooklyn Tabernacle much like a tourist would, to check out the choir. It's impressive, but soooooo charismatic that there's no way I could handle it every week. The next Sunday, I went to Christ Tabernacle which is walking distance from my place. It was equally as charismatic, but smaller and more concert-like. All the lights were out except for those lighting the stage. I go to church to worship with other believers and it defeats the purpose if I can't see them beside me. I'm better off having church at home by myself. The next church I went to was another one within walking distance where I learned that it's a year old church plant consisting of 20 people. The worship leader is also their pastor and it's just him and a guitar. Poor guy, he's probably exhausted. I was really tempted to commit to that one, but decided I'd check another one out that Diane from RCF recommended. She mentioned it the week I moved here, but the only thing that prevented me from checking it out earlier is that it's a 30 minute commute into Manhattan and I like the idea of being in the community where your church is. The thing about this church is that, since it's in the heart of Downtown, very few of its members actually live in the area. Most of us take the subway there. So it's an interesting twist. It's Redeemer Presbyterian, the Downtown location. Redeemer is the church plant that Tim Keller founded. He's sort of an influential guy in Christian circles with some great books to his name. The Downtown location isn't where Tim preaches and that's something I like because then you know that the congregation isn't there because of Tim or his celebrity factor per se. 

So Sunday, I headed downtown and went to Redeemer. I got there a bit late due to getting stuck in a rainstorm (complete with flash flood warnings sent to my phone), but when I entered, they were singing "Mighty to Save" and the room was full of young adults. It was a shock because well, quite frankly, I haven't been to many (if any) churches that draw in, nourish, disciple, challenge, and above all, engage young adults. I'd say there were about 100-150 of us there singing together, studiously taking sermon notes together, greeting each other with smiles and hand shakes. I was in awe. As another side note, the majority were Asian-American, and even though I hadn't thought much about it, that's something that gets me really excited. While I don't know my demographic all that well, I know that if you go back just a generation or two, you'll find the generation that has English as a second language and strong cultural values that don't include Christ or even the concept of him. Now I'm one of the lucky ones. I'm a 4th generation Canadian with Christian parents, a set of grandparents that brought their kids to church, and a great grandmother who was a Christian. So that's what I grew up with, but still figured out on my own such that my faith is personal and not a product of habit. But when I look at these people my age, I know that some of them may be the first ones in their family who pursued Christianity on their own without any background help, or perhaps more impressive, overcoming a background that was routed in other philosophies and superstitions. All these factors solidified my decision that this is where I'll be Sundays and I'm excited and relieved too. It was something I was praying for and asked others to pray for too. 

Just a little rain to greet me as I resurface from the subway

This week was my second week on Blue 1 and also the last week the interns would have with my resident and I before moving onto their next assignment in the hospital. The long weekend really burdened all the teams with maxed out lists. We'd have patients admitted to our team, but because we were out of beds, were still stuck in the ER, which was beyond congested. Every room was packed down there and the halls were lined with stretchers of people. Rounds doubled in length and it was tougher to manage all the patients and give them the level of care you wanted to. Tuesday's call shift was jam-packed but successful. Thursday's call shift, marked the day with codes that caused my scale to lean more on the deceased side. I knew it was inevitable and sure enough, halfway through my rotation, death is winning out on codes. We take special courses to get certified to participate in codes. ACLS certification classes involve you going through a megacode. You may recall I did this in Saginaw. You run through all the possible arrhythmias and scenarios to successfully revive a dummy. Most of the rhythms either involve defibrillation, or electrical or pharmaceutical cardioversion administered throughout rounds of CPR. Unfortunately, what we experience most of the time in real life is what we call a "non-shockable" rhythm. It's a situation where applying an electrical shock to the heart serves no purpose and the pharmaceuticals you use are educated guesses at what could be wrong (what we call the H's and T's). Such was the case for Thursday's codes. Over 20 minutes of CPR, addressing the H's & T's, and then it was called and time of death was given. Thursday's patients were very old women with many chronic medical problems. So none of them were a surprise, but it's still a loss. With those patients, talking to the family afterward isn't a tough task.

Death is a necessary part of life. That's an important thing to understand in our field, and I think in general. Some may think it's our job to save the life of their terminally ill 95 year old grandmother no matter the cost or invasive means involved, and in certain situations, we're forced to do that. It's situations like that that I still struggle with. WARNING DICLAIMER - it's going to get a tad graphic and crude... There's something in me that feels like the biggest asshole when I know I've broken an elderly person's frail ribs with my compressions so I can make their failing heart pump blood throughout their failing body. Nothing feels right about it, other than that I'm legally obligated to do so because the family demanded it and the patient didn't have an advanced will or directive in place to indicate otherwise. Honestly, I hope I never stop feeling like a jerk when that happens. I'd be worried if I felt completely fine with it. Don't get me wrong, I'll do my job and whatever is required of it, even if it feels ethically uneasy. By no means am I forcing you to adopt my opinion regarding end of life care (technically, I haven't even explicitly stated my opinion on it). I'm merely stating how I feel in certain situations. The only saving grace I have (and I do believe it's grace) is that those moments don't stick with me or eat away at me when I go home.

The toughest cases to shake from my mind are those that involve things that seem to go against the standard course of life. So this week, it's my 23 year old patient with juvenile diabetes that has complicated her life beyond imagination. I haven't dealt with juvenile diabetes yet because it's not that prevalent in Internal Medicine. You're used to seeing old adults with Type 2 diabetes, but not young adults with Type 1 with major complications. Kidney failure, respiratory failure, congestive heart failure, and the list goes on. All she wants to do is go home, and home is a nursing home, but I get that sentiment. It's not the existence anybody would want for her, but even though most of her housemates are more than half a century older than her, the activities don't cater to her, and the food is soft and kind of flavourless, it's still home. Unfortunately, even though she's been around for nearly a month, she still has active issues going on that need treatment and our attending doesn't feel comfortable discharging her yet. It wasn't until Friday when I really struggled emotionally. During rounds and the usual "I want to go home" talk with her, our attending decided to say "You know what. You're my son's age and the mother in me says I can't let you go without making sure you're ok first." Tears were welling up and I had to look away and step behind the interns to hide my face until I got my emotions in check. While it's classic countertransference I just witnessed, it showed how personal this patient's treatment was. It's that kind of stuff that despite my best efforts, come home with me. I have a distant cousin from Texas who is now the Medical Director of Palliative Pediatric Care at a hospital in Ohio. I know I wouldn't be able to handle that kind of medicine, but it speaks so much to her fortitude to be able to provide such a necessary role and not let the depressing work destroy her. I'm not saying there aren't nights when she cries herself to sleep. She's not a robot. She's an incredible person with a huge heart, and she's able to put herself back together in order to keep doing the awesome job she's been doing. I think I'd be an emotional wreck after a month in her shoes. To each their own and I'm glad she's found hers and I know that hers isn't mine.

Today I was up before 8am because my brain's not used to sleeping in later than that apparently. I decided I'd walk around the neighbourhood in search of a bagel. New York's notorious for their bagels and I love bagels in general, and yet I hadn't taken the time to eat a single one since being here. I searched google and found a little bakery/cafe a few blocks away. A tiny space full of hipsters. I felt like I was home, save for the rude New Yorker who yelled from a few people behind me in line, "Hey, is anyone up front taking orders here?!" Turns out, she was the boss and didn't seem to notice her staff making drinks, crafting sandwiches, cleaning up spills, and you know, the short girl at the till taking orders. Oh New York, too much hustle and bustle that overflows into a lazy Saturday morning, makes you the perma-PMS version of Vancouver. Seriously, stop to take in the beauty that surrounds you. I ordered the "New Yorker" on an everything bagel. It's a fried egg with cheese and bacon sandwiched between a bagel that had the classic crispy crust protecting a chewy dense inside. It was satisfying and more than substantial. Walked around a bit more before heading back home to study. For dinner I met up with Joanne in Midtown for Korean BBQ, a couple other classmates were going to join us, but things came up. So we had a feast to ourselves and feast we did. We finished the night off with a nice stroll. We stopped by the UN center but all the flags were down. So I didn't take a picture because there's nothing pretty about naked flag poles. Perhaps another time.

MEAT!!!!

Nice evening stroll