Yikes!

Isn't it amazing how one simple letter can change your whole day? I came home from a relatively painless day at work, and checked my mail. Not unusual, I had a letter from Emory Alumni. I assumed they were asking for money as usual - I wish!

No, instead of asking for a few thousand dollars (which would have been less painful) - they wanted to invite me for my 10 year reunion. Not mind you my ten 10 college reunion - MY 10 YEAR MEDICAL SCHOOL REUNION!

I can't believe I finished medical school 10 years ago. I know it sometimes feels like a lifetime, but I tell myself that is just from the lack of sleep. According to my letter today, it was an ACTUAL lifetime ago.

Most depressing - I still don't have a "real" job. I'm going to bed and pulling the covers over my head.

Wilted!

I love this picture - it is so perfect for how I feel today. I am not sure it photographs that well, but I bought these beautiful flowers at Trader Joe's. It has become my new thing to buy flowers for myself each Friday. When I bought these, the daisies were of course not wilted. They were incredibly cheerful and energetic looking daisies. That was Friday. Today when I came home from work they looked exactly like this. I couldn't help but to burst out laughing. These flowers somehow had the same weekend that I did - I don't recall seeing them at the hospital, but they certainly look like they were there.

I drank the Kool-Aid

So for several years now, I have tried to convince myself that I was different. (I know that I am definitely unique, but I mean something else.) I have told myself that I am not the "typical" Thoracic surgeon (for this blog Thoracic includes both heart and lungs). As a specialty, we are often admired and respected, but not the ones that you are buddies with. I arrogantly believed that I was wasn't like them.

Today I found out differently. I was given the "opportunity" to go to a Medical Oncology national meeting being held here in Philly. Today's topic was the treatment of lung and esophageal cancer - so of interest to me. National association meetings are unique experiences. I can still recall my first trip the the American College of Surgery. Today was my first opportunity to see how the Medicine guys did it - let's just say differently.

Thoracic surgery meetings are funny to me. If you put a lot of Thoracic surgeons in a room, you are guaranteed a lively debate (if not a true fight), lots of arrogant bragging and an incredibly formal proceeding. For the meeting itself, everyone in the room will be in a black or dark blue business suit - including the women (few that they are). I wore dark green once and stood out like a sore thumb. For the evening events that call for casual - no blue jeans or dockers for us. Mean wear dress pants with a sports coat - tie still a necessity. Women wear nice pants/skirt with twinset or other equally formal top.

Although we think nothing of calling each other out during presentations, the rest of the conference has a very polite, but formal air about it. He may call you an idiot trying to kill people during your presentation, but will be smiling and telling you about a similar case that he had during the break. It is all about being seen and heard. You have to "play the political game". All conversations involve some topic that is being presented or relevant to the specialty. No small talk here.

Food is always plentiful, and coffee until noon and alcohol in the evenings is a must. The prime seating in the room is always the back rows. I think mostly because no one stays seated for long, too much ADD in the room. People freely wander around the back of the room and play on their Blackberries. Anyone feels comfortable interrupting the speaker at anytime for questions or comments.

This is my comfort zone. These are the things that I am used too. This is not how the medicine people do it - by a long shot. I show up in my suit (which I can finally fit into again), and am one of the few. The only others were all my Thoracic surgery colleagues. There were people in blue jeans - they don't even let our technical staff wear blue jeans. People quickly filed into the conference room and took their seats near the front. No one had to come out to the buffet and threaten people to come inside so we could get started. During presentations, no one spoke or got up or played on their phones. People only asked easy questions, and never openly disagreed with the presenters. During breaks, conversations were about children, sports and vacations. I felt like I was on Mars. Turns out I am much more of a Thoracic surgeon than I thought because it all felt wrong. Turns out I like formality and inattention and contention - it makes things interesting.

The content of the conference was okay. It reinforced what I already know. Medicine guys spend way to much time thinking about things that don't seem to make much difference in the long run. All I can say is pour me another glass. Turns out the Thoracic Kool-aid tastes pretty sweet to me.

Academic days

In Academic medicine (doctors who practice at teaching institutions) there is something known as an "academic" day. For surgeons, it is a day where you don't operate or have clinic. The time is supposed to be used for academic pursuits - i.e. bench research, paper writing or other administrative issues. Of course the residents don't get these, but the attendings seem to enjoy them immensely. Yesterday I took my first ever Academic day.

We had no cases yesterday - not sure why, but it just worked out that way. Therefore, I decided it was a waste of time to even come into the hospital. (The second year resident was on call and had to be here anyway.) Now you are probably thinking - great, she finally wrote that paper and finished those two book chapters she has been complaining about - well you would be wrong. My academic day consisted mostly of grooming with a little inauguration thrown in.

I got up at regular time and went to the gym. Turns out that there is actually a decent number of people at the gym starting around 6 am. I showered and had breakfast. By then the inauguration was starting to get interesting so I spent the next 3 hours sitting on my couch. . . tears streaming down my face at times. (It was in my opinion a fantastic ceremony. I am so excited to be living in this Country at this Time.) I had a hair appointment at two which took 3 hours, but the good news is that I actually like it. No horror stories like last time. I went to a real salon. The hairdresser thought it was hilarious that I had been so traumatized that I had not had a haircut in 5 months. I followed the new do with nails and finally trimmed up that uni brow problem. By now it was 6:30. Guys just don't understand how time consuming grooming can actually be.

I actually did participate in some academic pursuits - we had journal club. Sitting around eating shrimp while several "famous" cardiac surgeons yell at each other is actually quite fun. I would highly recommend it. All in all I got a new President, hair cut and nails out of the day. I would say it was a very productive day for "academics".

Trouble with expectations

Why do I even bother? I make all these fabulous plans for my post call day, and fate always intervenes. Since you haven't heard from me since Wednesday, you can assume life has not been normal. My transplant Wednesday night actually went fairly well. We finished by 1 am so I foolishly thought - I'm going to get a couple of hours of sleep. I tucked him into the unit, made some quick rounds on the floor and was heading to the call room.

Didn't even make it past the door when I got called for a consult to the MICU. Can I just go on record as to how much I hate the MICU. For some reason, to work in the MICU you have to forget everything that you ever learned in medical school, and spend all of your time trying to figure out how to get surgery involved in your patient's care. As a cardiothoracic surgeon, I am usually protected, but not always. The incredibly frustrating part is that it was a ridiculous consult. I spent one hour trying to nicely explain to the intern, resident, fellow and ultimately attending why it was a ridiculous consult. At 3:30, as I saw my chances of sleep slipping away I became progressively less nice. I don't think I actually called the attending stupid to his face, but I did imply that he had no knowledge about that to which he was speaking.

I finally convinced them that I probably understood ECMO better than they and let the MICU. This time I actually made it into the call room, and had actually crawled into bed. I hadn't quite closed my eyes when my phone went off again. Type A aortic dissection being flow directly to the operating room. Needless to say that sucked up the rest of my night, and a good portion of my morning.

When I finally walked into my house Thursday, I crashed straight into bed. I didn't even shower first which I never do, but I was afraid I would fall asleep in the shower. I woke up briefly for an early dinner, and then fell right back asleep. I accomplished absolutely nothing on my list - not one single thing. Friday after work I ran to the grocery store. My plan was oil change on Saturday and grooming on Sunday. I made it to my car on Saturday, but unfortunately not much further. The President-elect was in town, and traffic was a nightmare. I grew frustrated and went back home. Sunday there was snow on the ground so I decided I could live with my unibrow for a little longer.

If you are keeping track - 1 for 7.

Post Call Days

I am on call today - so you might be wondering why I titled this blog post call day. The reason - post call days are the only thing that gets me through the call these days.

I am SO sick of call. I understand that I will be "on call" for the rest of my life. However, I only have 5 1/2 more months of in house call. In house call, for those who haven't had the joy of experiencing it, means that you come in one morning and go home the next day. You literally spend the night in the hospital taking care of the patients. I thought I had finally out ranked in house call after my second year at Vanderbilt, but they still do it here. Call nights are usually busy, but even the quiet ones are not restful. It is like standing under a guillotine waiting on the blade to fall.

Tonight is not a quiet call night. I am currently waiting on a pair of lungs to show up for transplant. In the meantime, we have 28 patients in the CTICU, 68 pts on the cardiac floor and my own thoracic patients. Unfortunately, I have never even met the cardiac surgeon that I am transplanting with tonight. He normally works at a different hospital and rarely takes call here - until tonight our paths have never crossed. This adds a little extra anxiety to the case because I have no idea how he "does things" so it is learning on your feet.

The one thing that makes tonight bearable is knowing tomorrow is my post call day. Prior to the 80 hour work rule restrictions, that statement didn't mean very much. You worked just as hard your post call day as you did any other day. However, the restrictions have been good for something. It is now federally mandated (so we do it most of the time) that we go home before noon the day after our call day. This may not sound like much to you, but this is a whole 6-10 hours of the day that I normally don't have to act like a normal person.

And boy do I have plans. The list of things that I would like to accomplish tomorrow is incredibly long - it always is. What will actually accomplish often depends on how bad the call night becomes. If I can pull off a couple of hours sleep, I am hoping for a mail run, Target run, oil change and pedicure/brow wax. If I get no sleep, I should go for the oil change, but will probably whittle down to the brow wax and pedicure (girl has to have her priorities).

Here's dreaming of post call days.

New Appreciation

So almost every day of my operative life, I injure the lattismus dorsi muscle in some way. I either move it out of the way of my axillary thoracotomy or plough right through it for every other thoracotomy. Of course these are the lats on other people (my patients precisely). Yesterday as I mentioned, I worked out my upper body for the first time in . . . well forever. This evening, my lats HATE me.

It is not that a little soreness feels good because you know you worked out thing. It is my arms can't be raised higher than waist height. I should be concerned about driving home. However my biggest concern is that I still have to go close a chest. I did a sternotomy so that ENT could take out a big thyroid cancer. Putting the sternum back together is mostly about technique, but some chest strength is required. I am going to be embarrassed if I have to ask the ENT resident to push a wire thru the sternum for me.

According to my schedule, I am supposed to work out lower body tonight. We will see what time I get home. I am on call tomorrow so should really suck it up and go regardless, but should and will are not always the same for me. Oh well, off to try to close a chest.

What was I thinking?

Back at my fittest, Jill had talked (bullied - semantics) me into lifting weights. I never learned to like the abs or glut exercises, but really enjoyed the arm exercises. I also enjoyed the results. I had truly toned arms and really enjoyed wearing sleeveless shirts for the first time ever. Like many other aspects of my fitness, I had let the weights go.

As part of my New Year's resolutions, I wanted to reclaim them. I had already restarted the eating well and cardio, but wanted to reclaim the toning. I am trying to figure a way for Jill to quit her general surgery training (I mean come on - she is in the last year - what else does she need to know?), and move here to train me. She is without a doubt the best work-out partner I have ever had. She completely kicked my butt, and never let me wimp out or get away with any BS. However, until I can make those arrangements, I started retraining on my own.

Did I mention that I started today? I did upper body. You know how they say the soreness doesn't kick in for 24-48 hours? - that has me VERY scared. My arms are so tired that I could barely lift my arms to shampoo my hair just now. We won't even talk about how poorly I shaved my pits. I am seriously nervous that I may not be able to move my arms by this time tomorrow. Stay tuned.

Simple pleasures

I picked up these roses Friday at Trader Joe's. They had them on sale for 7.99, so I couldn't resist. It is funny how such a simple thing can actually bring so much pleasure. They have the most amazing smell especially considering they have to be greenhouse grown. I have them in my living room and every time I see them I smile. I would say that is definitely money well spent. Here is wishing for more simple pleasures.

Selfish Saturday

No huge surprise to anyone - I have been a little stressed lately. As I was coming home late last evening, I decided it was time to quit whining about my life and do something about my attitude. I gave myself permission to make today all about me. I would completely take myself out of the outside world, and make peace with myself.

I started by turning off my cell phones. Don't get me wrong, I love the convenience of cell phones, but occasionally I miss being free. It seems that lately in life we are always accessible. We never have time simply to enjoy our own company without interruption. I am sure when I turn them both back on in the morning there may be hell to pay, but it is a risk I was willing to take. Secondly I slept late. This was harder for me as I have often complained. However, last night I decided to put my medical degree to good use. I medicated myself. Don't worry - it was nothing more that a big dose of benadryl, but it both helped me fall asleep and stay asleep.

When I finally got out of bed this morning, it was almost 9am. This is incredibly decadent for me. I had some breakfast and then ran downstairs to the gym. I then spent a few hours reading before sitting down to lunch. I had lunch with a few West Wing reruns, and then took a nap. This evening, I have watched LOST and played with my iTunes reworking some play lists. I enjoyed a nice relaxing bubble bath, and even spent some time in a few yoga poses. Next up, I am heading back to bed.

I haven't even spoken today - probably only something you can do if you are single, but kind of weird. Don't worry, I haven't gone off the deep end. I simply needed a day that was all about me. I know this sounds incredibly selfish, but for me it was simply about recharging. I will reenter the world tomorrow with more energy than I have had lately. I have also made peace with myself. I won't say that I will still not worry occasionally, but have accepted that what is meant to happen will. It is time to start putting some positive energy back into my universe.

Tomorrow I am making my catch up with friends day. So we'll be in touch.

Lions, Tigers, Migraines - Oh My!

Not unexpectedly I got a migraine today. Perhaps I should explain. My mom suffered from migraines the entire time I was growing up. Her trigger was hormonal. Once she went through menopause, they magically disappeared. I spent most of my twenty's thankful not to have inherited that particular trait.

Then I started my cardiothoracic fellowship. During my first year, I lost peripheral vision one day as I was heading home. In a near panic, I headed back into the ER. One incredibly long work-up later, it was declared that I had an "optic migraine". I have had a few since then. My trigger seems to be stress. I know - you're thinking "Wow you really did pick a bad career." It is not "normal" stress that triggers for me. I can handle stressful cases and patients with relative ease.

The stress that triggers for me is more related to my control issues. It is the stress that comes from having events outside of my control. A big job search for example. The practical part of my brain argues that it is ridiculous to get so worked up about such things. After all, things happen for a reason - what will be will be. However, it turns out that a huge portion of my brain is very impractical, and it actually always seems to win in these situations.

I have tried to relax and let go, but it is much easier to say than for me to actually do. I have a bad feeling that it is going to be a rough few months - (Sorry Kris and mom).

I need a job

Every morning for more years than I care to recall, my first thought when I open my eyes is "crap - it is early". (I am by nature not a morning person. How did I end up a surgeon you might ask - BAD career planning.) For the past week, my question has changed. When my eyes pop open these mornings, the first thought that goes through my head is "oh my god, I need a job." I suspect this thought also has something to do with the fact that I am not sleeping well and having strange dreams when I do sleep.

I have often bragged about the fact that I can fall asleep anytime, anywhere and on a moment's notice. Surgery can take the credit for that one. It also gets the blame for the fact that I have turned into an incredibly light sleeper and can not sleep with anyone snoring or even breathing hard for that matter. Stress has always affected my sleeping. Early in my life and training, sleep was a great anecdote for stress. I fell asleep and planned to think about it tomorrow. As I have gotten older, and my responsibilities have changed, stress now prevents me from sleeping. It is actually kind of spooky. If I wake up on call for no apparent reason, I will go and see all my patients. Almost 100% of the time, something is wrong with one of them. Eerie but true.

The strange dreams are new. I usually don't recall dreams. According to Freud that is a sign of a deeply repressed personality, but I decided years ago to let that go and move on. Lately, not only do I recall them, but they confuse me. I have dreams about weird jobs in strange places. I have dreams of moving to strange places with no job or marrying for money. I am sure these would all be way to easy for Freud, but at least I am remembering a few.

Wishing for the "crap it is early" days.

One of them

Well, it's happening - I am assimilating. When I first moved here, I noticed a couple of things right off the bat about Philadelphians. One, they are not the friendliest sort - don't even try to make eye contact on the street. Two, they all constantly walk around EVERYWHERE with their ipods in place. Once it started getting cold, I realized that they are also crazy. It can be ridiculously COLD here and people are out on the streets everywhere. Often, with no apparent purpose, I think they just stand on the corners and chat.

I was quite smug in my Southern superiority. I smiled to everyone I passed, enjoy the sounds of the city not drowned out by music, and like normal people abhor the cold.

At least until today. As I mentioned previously, I am on call this weekend. I had only four people to see this morning, and no plans to round until 8 am. Therefore, I decided to walk to work. I did this a lot back in the summer and fall. It is about 22 blocks, but a nice walk if you have time. However, aside from last night by necessity, I have avoided walking the 20 minutes in the cold. Did I mention it was 24 degrees this morning in Philadelphia? Did I also mention that Susan bought me a new ipod touch for Christmas, and it seemed the perfect time to try it out?

Off I start, at a slow leisurely pace with ipod in place talking to no one on my stroll to the hospital. I have become one of them. I really need to get out of this town.

P.S. Happy Birthday Giulia - Can't wait to see pirate pictures!

Better days

I will give a little narrative of my day. Not because it was one of those great days that you will remember for years to come with a smile, but simply it is easier to find things to laugh about than to cry.

I am on call this weekend. I am not actually in house on call this weekend; I am just covering Thoracic. Usually this means that I go in each morning, round on my patients and then go about my business for the rest of the day. My life is seldom that simple. I went in this morning to round on my four relatively boring patients, and ended up spending 4 hours. We had 3 consults that had to be seen, and time has a way of escaping at the hospital.

I left work - made a quick run to Target and then headed home. I received LOST 4th season for Christmas and am trying to rewatch the old seasons to remind myself of things that I had missed. Therefore, I was happily camped on my living room floor putting my LOST puzzle together from Season 1. Then it started. A patient that I had just met that morning - NOT on my service - had a syncopal episode. For some reason, they wanted me to evaluate her. I took a trip back to the hospital - stated she did not drop her hemoglobin from anything that I could fix, and suggested a CT scan. I returned home.

Two hours later, I am told that she now has free air in her chest. Free air is a surgical expression that is completely ridiculous. It simply means that air exists somewhere in the body outside of the boundaries of where it belongs. It has escaped "free". It usually portends some form of surgical emergency - bowel perforation, lung collapse, esophageal perforation, etc. It almost always requires some type of intervention that is quite expensive. Regardless, I now have to go back to the hospital a third time to evaluate.

I was muttering quite a bit as I got ready to leave. It is not that I had huge wonderful plans, but it is cold outside and I was comfy on the floor with my new blanket. I got downstairs, dropped off my rent and walked out to the parking deck. This is where I encountered problem one - no car keys. Correct, I had walked out of my apartment without my keys. GREAT! I have to ring the bell to get back into the building - it automatically locks and you need a key fob to get in - and head to the front desk. I am told that the on site maintenance man is currently not on site. It will take at least an hour to get me back into my apartment. Free air waits for no one, so I caught a cab to the hospital.

Once there I head to the ICU where the patient now is living. She looks great, but definite problems exist with her CT scan. It becomes obvious that she at least had an esophageal perforation recently, and I need to see if she still has an opening. I take out my phone to call my attending, and it dies. Not battery low death - electronic black out dead. Usually not a huge problem. I am the nerd with two phones (work and personal). Of course, my other phone is sitting right next to my car keys - at my apartment.

Eventually I am able to contact all the right people and arrange for the study. Even though I have ordered an emergent study, I am not naive enough to think that it will happen in under four hours. Therefore, I decide to head home and pick up my car and my working phone. I only had my hospital ID and my license with me. I spent the only cash I had on the taxi into the hospital. Therefore, I get to walk home in the dark with a dead cell phone. I go out all the time at night here in Center City, but let's just say that the hospital is not in a great neighborhood. I was a little freaked out the first 10 minutes of my walk, and I am not easily freaked.

Needless to say I made it home quite safely if not warmly. I was able to get back into my apartment and have some dinner. Swallow study just finished (3.5 hours after ordered) and no ongoing leak. So at least I don't have to go back in to operate. Some days, it just doesn't pay to get out of bed. Hoping for a better tomorrow.

Resolute!

So about this time every year I get into the "spirit" of the season and make resolutions. About this time tomorrow, I have forgotten said resolutions and gone about my way. This year I have decided to actually put thought into my resolutions and be resolute about keeping them.

Resolution: Regain Optimism - I am by nature an optimist. However, as of late I seem to have misplaced it. Therefore, I am resolving to get it back. I will again believe that people are basically good and things happen for a reason. (On call today, truly putting this resolution to test.)

Resolution: Re find Outer Self - Most of you know me as a fairly girly girl. I like my pedicures, abhor trailer park roots and spend a fortune on clothes. I remember that girl, and I recall that I liked her a lot. I resolve to start dressing for work again, spending time (and money) on hair and grooming. I don't believe that people should be judged on appearance, but I do believe that how we feel about ourselves on the inside is published on the outside. For me I think the outside is a reflection of what is going on inside. Which brings me to my last resolution.

Resolution: Be More Selfish - WHAT? Yes - I said be more selfish. I resolve to actually say no to things that I don't want to do - both professionally and personally. I accept that occasionally I have to disappoint others. I resolve to be selfish about taking care of my inner self. I will give myself weekends with friends, days of complete solitude, trips to the gym, long walks and hot bubble baths. Once these things were a regular part of my life, but somewhere along the way my life got in the way of me. I selfishly want me back.

Hope you guys make conscious resolutions this year, and here is hoping we can all live up to them.