Wednesday, January 27, 2010

Miss Independent

There is something very liberating about being single. It has been over 4 months since The Break-Up and I am happy to report that I am, well, happy! Truly and unequivocally happy. My life is rich with great friends (Steve and Chevy, you know who you are) and a job that I love. I eat/sleep/socialize/exercise/travel when I want. My schedule and future plans are entirely my own. The messes I clean up are my own. There is no compromising or joint decision making. And the only person I answer to is me (and the Big Guy upstairs).

I know this sounds incredibly selfish. I also know that I would eventually like to find the Man Of My Dreams. So how does a serial monogamist working at an all-women’s hospital set out on this mission? Seriously, every “real” boyfriend I’ve had I have met in school (high school, college, medical school). I’ve never really dated before and the few first dates I’ve had have been painfully awkward… I mean, how do you get past the superficial crap and find out what a person is really like? And then there are the dating rules of the 2000s. What are they?!? For example…
    * Who pays for dates nowadays? If he doesn’t offer, is that a deal
    * Are there any off-limits topics for first dates?
    * Who decides when the date ends? How do you do this gracefully?
    * What’s the appropriate way to say goodbye? (handshake, hug, kiss
       on the cheek?)
    * Who brings up the idea of a second date? Are us ladies still waiting
       for him to make the first move? Does the 2-day rule still apply? 

Tuesday, January 26, 2010

My New Roommate

Meet the newest member of my family – Pablo Neruda (named after my favorite poet, the granddaddy of love poems). He is a male betta fish and represents about all the caretaking I have time for right now. He’s the perfect roommate, really. He’s quiet, doesn’t eat my food, AND he is nice to look at. Loves it!

UPDATE: So I took my Dad's advice and put a mirror up in front of Pablo's bowl. Man, did he get angry! He puffed himself up to look as big as a 2 inch long fish can look. And just as quickly, he would scurry away, as if he was frightened by his own reflection. After a minute, he would muster up his courage to attack the mirror again. Adorable!!! As I delved into my Betta fish studies, I also learned that doing this mirror trick or chasing him around the bowl is much-needed exercise and can actually prolong his life. (Apparently Bettas are otherwise lazy, eat more than they need to, and are prone to obesity and degenerative diseases). Sounds like 30% of the U.S. population, no?

Tuesday, January 12, 2010

All Clear!

It’s true! I am infection free! My patient’s HIV and Hepatitis panel came back negative today - I could have done cartwheels through the Intensive Care Unit, I was so happy. As soon as I laid eyes on the test results, an enormous weight was lifted off my shoulders and all I wanted to do was run, cheer, skip, dance, and sing for joy!

It’s funny how much I take my health for granted. The ability to get up in the morning, the energy that carries me throughout the day, the ability to think clearly, the freedom to eat what I want, the strength to run and challenge my body – in one split second that could have been gone. Forever.

Realistically I know this probably won’t be the last scare I have. But hopefully it will be enough to keep me on my toes for awhile. And at the very least, it is a precious reminder to appreciate the health and body I have today.

Monday, January 11, 2010


Argh. I had my first “needlestick” injury today. Okay, technically it wasn’t a needle. It was a big bloody scalpel that I grabbed the wrong way. Not much better. In fact, I’d wager to say a whole lot worse. It all happened so fast. I was stitching a central line into place, grabbed my scalpel to cut the suture, and STAB! In shock I looked down at my glove, which was filling up with blood. “Fuck!” I say out loud. (Good thing my patient was intubated and sedated, lest he hear my potty mouth.) The hour that followed was one of sheer terror.

I have many friends and colleagues that have been stuck by sharps while practicing medicine. In fact, one study showed that 99% of surgical residents have had at least 8 needlestick accidents in their first 5 years of residency(1). Regardless, nothing could have prepared me for the flood of emotions that would roll through me when it was my turn.

The first emotion: Anger. How could I let this happen? I'm a surgeon! I work with sharps all the time! I should know better! The anger quickly ensues into self-disparagement. If only I had been paying more attention… If only I hadn’t been so overconfident… if only, if only, if only.
Second emotion: Embarrassment. Great, now the team is going to think I am a total klutz. We have a super busy morning and I’ve just slowed everyone down with my ineptitude. I bet they are never going to let me place a line again. Stupid, stupid, stupid.
Third emotion: Outright fear. My life could completely and utterly change in this moment. This patient just came into the hospital this morning. All I know about him is that he is a drinker with acute pancreatitis. I have no idea if he has a history of IV drug use. Nor do I know anything about his sexual history. Is he HIV positive? Am I going to spend the next 4 weeks on hard-hitting antiretrovirals? Or worse, is he Hepatitis C positive? In which case, there will be nothing I can take to prevent transmission. It will be a slow and painful waiting game of testing over the next six months.

The risk of hepatitis C is what scares me the most and my imagination is getting the best of me. I envision myself in and out of hospitals, visiting with various GI specialists. I see myself sick from the effects of those heavy duty Hep C drugs. I see my skin turning yellow. I see my belly swelling with fluid and my bleeding difficult to control as my liver starts to fail me. I see the radiologist’s grim face when he sees my liver lesions on CT scan, suspicious for cancer.

Tomorrow I get the test results. Until then, all I can do is breathe.

(1) Makary, M. et al. Needlestick Injuries among Surgeons in Training. New England Journal of Medicine. 356 (26). June 28, 2007.

Sunday, January 10, 2010

The Things They Don't Teach in Med School

There are many schools of thought on how “professional” physicians should be with their patients. Is it appropriate to call a patient by their first name? Is it appropriate to pat the back or squeeze the hand of a patient? Is it appropriate to cry with a patient? Many people will say a doctor should keep their distance from patients, for the sake of maintaining an aura of professionalism. Others will tell you that staying human is the most important aspect of doctoring. Particularly when I’m dealing with bad news, I learning that I prefer the latter...

Her name was Y.L. She was a sweet, chubby, Puerto Rican woman in her early twenties. She and her boyfriend had been trying for 2 years to become pregnant. By the time we met, she was approximately 7 weeks along. I met her in Triage, where she had presented with some vaginal spotting and cramping. I wasn’t overly concerned. Contrary to popular belief, many women have spotting throughout their otherwise normal pregnancies. I bring her to the ultrasound room and set up for a speculum exam. There were about 3 tablespoons or dark blood in the vagina. “What is it? What do you see, Doctor?” Y.L. was anxious. “Just a little blood, I’m still looking,” I respond. I use large cotton swabs to clear my view of the cervix, but the vagina continues to fill up with blood. I use a pair of ringed forceps and sterile gauze to soak up the blood instead. And then I see it. Shit. Fetal tissue protruding from her cervical os. I pull the tissue with my forceps knowing now that this woman is miscarrying and the only way to stop the bleeding is to help her pass the fetus. I keep pulling, slowly, to evacuate the tissue completely. She asks again, “Doctor is the baby alright?” At this point, I have to tell her. “Y, I’m so sorry. It looks like you are passing the pregnancy. You are having a miscarriage”. Before I finish my sentence, she starts to wail. The pain in her voice is piercing. I try desperately to finish retrieving the fetal tissue as her body shakes with tears. Her partner, a stoic young man, looks down at his shoes. A tear falls to the floor.

Finally the pregnancy is out. The bleeding stops. I do a quick ultrasound to make sure her uterus is completely empty and then I leave them alone in the room.

Upon heading back to their room, I was at a complete loss of what to say or do. The “doctor-ly” thing to do would have been to give the couple a little Miscarriage 101 – why it happens, what to look out for, risks that it will happen again. But that picture felt wrong. It felt cold. Devoid of empathy. When I headed back into that patient room, I knew there was no real “doctoring” I could do. There was nothing I could say or do to bring her pregnancy back. So I took off my “doctor hat” and walked in as myself. I hugged her. I let her cry on my shoulder. I reminded her that this was not her fault. Was I appropriate? Was I professional? I don’t know. But I do know this. I was human. Between women, sometimes this is all we need. When she looked up at me afterward and whispered "Thank you. God bless you" through her tears, I knew I had done the right thing.

Saturday, January 2, 2010

Impromptu Baby Catching

I’ve done it. I’m finally reaching a point where I am prepared to catch a baby at any time, at any place. In the wee hours of the morning this week, I was sitting in the Triage (our hospital’s women-centered emergency room) working on a patient note when a nurse runs in. “We need a doctor to check room 12 – she’s uncomfortable and feeling rectal pressure!” Now clearly pregnant women in labor are uncomfortable. But “rectal pressure” in the world of Obstetrics can only mean one thing. The baby is coming.

I ran to the patient room. My co-resident lifted up the sheet to do a cervical exam (which tells us how dilated she is) and lo and behold, what do we find? The top of a big baby head trying to make her way out of her vagina… I throw on a pair of gloves and in a fraction of a second I am prepared to deliver this baby on a hospital stretcher. In the emergency room. As the largest diameter of her head pops out, I am hit with a tsunami of amniotic fluid. My favorite fleece sweater sleeves are soaked, as are every part of my unexposed arms. The baby’s shoulders and body follow easily after. I lay the baby on to the stretcher, clamp and cut the cord, and hand her off to mom with pride.

I gaze down at pink tinged fluid covering my arms and sweater. Even during this breach of universal precautions, I am pumped. True, the baby would’ve come out with or without me there. But being able to jump in there in the nick of time and ease her way into this crazy world was awesome. This is why I love my job.

A New Year, a New Decade

Happy New Year everyone! As with every year, 2009 was filled with ups and downs. Being a glass-half-full kind of girl, I like to look back on the ups. The historic presidential election that not only got Bush out of the White House, but got our first African American president in. The beginnings of much-needed health care reform. Jake Gyllenhaal becoming available again. (Haha, kidding on that last one. Sort of.)

In my own life, this was a year filled with events I have been waiting for my entire life: graduating from medical school, becoming a doctor, starting at a great residency program in a field that I am incredibly passionate about. I cherish being at a place in my life where I am comfortable in my own skin, where I am blessed enough to have health, a loving family, and wonderful friends on both coasts.

So what next for the upcoming year? I hesitate to make any big plans – I’m where I always wanted to be and would like to simply enjoy where I am at for awhile. Rather than focus on the future (which will inevitably come) I want to focus on the present. Live in the moment. Laugh a lot. And love.