frustration.

WHY DO I NEVER UPDATE THIS BLOG?!?!?!?!?!? i am frustrated with myself today.

Pseudomonas

My patient was a cachectic, elderly African American man with an amazing afro and a tumor the size of two soccer balls which was recently resected from his abdomen. As you can imagine, this left quite the gigantor sized hole around his middle, which necessitated a hefty skin graft and me, the intern, caring for this graft with thrice daily dressing changes. I did not mind this, as this man had a wonderful sense of humor and always a good show on the tube when i came to visit. All was fine and well with our soap operas and chats and daily wound care until the fever and the white count and that putrid greenish foam began to bubble up out of his insides.
Infection.
Pseudomonal infection to be exact. For those of you wise enough to have a job that has nothing to do with this bug, I've located some expert advice from Wikipedia on the subject. They explain that "P. aeruginosa is a rod shaped bacteria that secretes a variety of pigments, including pyocyanin (blue-green), fluorescein (yellow-green and fluorescent), and pyorubin (red-brown). It also has the ability to live at 42°C and thus is capable of growth in diesel and jet fuel, where it is known as a hydrocarbon-utilizing microorganism (or "HUM bug"), causing microbial corrosion." Obviously not a bug you wanna joke around with. So our team assessed and deliberated and decided to step it up a notch. Our three times daily dressings would now involve delicately removing pieces of dead tissue and nasty pus, pouring liters of Dakin's solution (ie. super smelly bleach) all over the man's middle, and then topping it all off with a thick juicy icing like layer of white silvadene cream (an antibiotic ointment). Fine by me, I thought. More time for the most recent All My Children episodes. Everything was going smoothly until one Saturday evening when i decided on tuna salad for dinner. I stopped by the cafeteria and returned to my call room with what i would consider as a better than average tuna salad sandwich. On whole wheat. I sat down to enjoy my dinner, had one bite and then remembered I'd completely forgotten about the third dressing change of the day. I pushed the food aside and went to collect the dressing materials. For some reason this evening the pseudomonas was a little extra bubbly and upon mixing with the silvadene icing became a very drippy pale green lumpy substance which splashed up out of the wound in my general direction with the repeated bleach washings. I dodged the drippings and once finished with the task headed back to my tuna. I went to take the first bite, when suddenly a few small dollops of creamy tuna slid out from the bread and onto my right forearm. I looked down at the dollop and did something right then that I will always regret. In what I can only explain as a ravished interns reflex, I leaned down and licked the drop of tuna from my arm. And then I stopped. Looked up. Dropped the sandwich. And thought about the very odd texture and taste of the substance in my mouth. It wasn't quite tuna. No, not like most tunas I'd had with the typical mayonnaise aftertaste and crunchy sweet pickles. No this was creamy and oddly bland, but with a distinct salty sour aftertaste and the fumey fragrance that was all to familiar, thrice daily to be exact. But how could, what could, no that could not have happened. And yet it had. I just put PSEUDOMONAS IN MY MOUTH!!!!!!!!!!!! OMG OMG OMG OMG OMG. I darted for the bathroom. Locked. Who is in there??!?!?! I scream in a muffled voice as I attempt to block off all entrances to my esophagus and airway scared to death about the possible repercussions of a pseudomonas ingestion. I begin banging on the door with my fists and kicking and finally an annoyed nurse emerges and I lunge toward the sink with one hand under the faucet and one hand firmly planted on the soap dispenser button allowing copious amounts of sudsy antiseptic to fill my insides. After a full hour of intractable vomiting and douching my intestines i emerged mostly alive and vowing to never be in the same room with tuna again.

I heart NY.

Tourists flock to New York to buy this shirt. I own it. Admit it. You own it.
But why is it, really, that we all love this city? Is it the bright lights of Times Square, the upper west side style "Sunday brunch"? the sidewalk cafes? or perhaps the availability of takeout from the continent of your choice delivered to your doorstep 24 hours a day?
Maybe. But truth be told, the past 8 months of my life, spent living in this big apple, have been the most difficult months in my 28 years. Well, i'm also exhausted and exaggerating. But it's been tough. I won't lie about that.
So this blog is my attempt to record what its really like to live in the big city. And maybe writing this down will help me remember why I loved this place enough to pack up my life in a U-Haul to be here. Or maybe not. We'll see.
I wake up around 4:45am, window open in my bedroom, there's a circa 1908 radiator at my bedside that I have no rights to control. So the smell and the dirt of the city slink into my room and fill the whole place with a reminder that I have 2 million roommates, half of whom are furry and grey. And I'm not referring to my greyhound Delhi who slowly pulls open her eyelids and pulls her nose out from under my left arm pit where she sleeps cozy every night. I get up. No need to change. I've dressed myself in my scrubs for this day last night before going to bed. This shortens my "get ready time" by exactly 4 minutes. Allowing me 4 additional minutes of sleep. This is crucial. I put my dansko clogs on my feet, the ones I've seen my surgeon mother wear for so many years, secretly embarassed for her style choices, and as I slip them on I am once again thankful for her sharing her wisdom and orthotics with me. My feet will survive another day. I walk to the bathroom, brush teeth, wash face, pick up Delhi bowel movements that didn't quite make it onto our makeshift "backyard" in the coat closet by the front door. Next I put on fleece jacket over scrubs, and then long white coat i'm still not certain I deserve, and then the knee length oversized down comforter coat, a scarf, a hat, some gloves, knee high galoshes, satchel and a big bag of trash for the curb. And don't forget the broom and dust pan. I will need these. I will need these because in the past week this big city has received 60 inches of snow, most of it on top of my volvo. And so I will dig myself out this morning with these tools because by the way I own no shovel because it won't fit in my apartment. So I lock the dead bolts and tromp down the flights and flights and flights and there he is and I almost step on him. The homeless man with the hat sleeping with no pillow and no blanket on the nasty parquet floor of the foyer of my apartment. And so I step over him with my bags and broom and the truth is I don't look all that different than him and I'm honestly just jealous he's sleeping in this morning. I step out into the dark morning with snow to my knees and I begin the search for my buried vehicle. The first step is to recall which street I parked it last. 73rd and Columbus? or was it Central Park West? oh maybe it was 74th on the south side? No it was definitely the north side. No the west side of the east side. When did I last drive? Was it evening? Is it morning? What year is it? And on my third lap of the 2 block radius the truth of my vehicle's location dawns and I throw my broom down and cry for the millionth time this month. IT WAS TOWED!!!!!!! AGAIN!!!!!! How could the NYPD do this to me AGAIN?!?!? Did they not see the 3 foot embankment of frozen ice surrounding my car the past 4 days?? Did they expect me to actually own a shovel?? Have they not seen my closet space??
I stomp and scream back to my apartment, step over my "roommate" once again, and drop off the tools it turns out I won't need today. I grab a cab, take me to the Bronx. Where?, he says. The Bronx. No one in Manhattan knows where the Bronx is. But I do. I work there. And so I give him directions northward and dig some face powder out of my satchel. Peer into the compact mirror. Look alive. Look alive.
I let the city of NY rob me of 40 more dollars for this cab ride northward and get out at the corner of Bainbridge and Gun Hill Road. And there it is. Montefiore Hospital at 5:30am. Again.
I'll fast forward through the day. And summarize my duties as follows. Start iv, draw blood, put in orders, steal juice from extra breakfast tray, complete 5,000 various medicare forms for 40 different patients, steal cracker from extra lunch tray, change nasty feet dressings, change nasty belly dressings, change nasty armpit dressings, round and round and round and round, and finally pee for the first time today at 7pm and then pack my satchel and pick up my allocated boxed sandwich dinner (the money for which is deducted from my salary each day and the only meal of the three that I've had a chance to partake in today) Get on my galoshes and the gloves and the hat and the coat and fight the blizzard to the number 4 train. And I sit down for the first time today. And I open my boxed turkey sandwich. And then he stands up and announces he just got here from Puerto Rico. His family isn't here. He has no one. And this morning he was forced out of the place he was staying and he hasn't eaten since Saturday and does anyone have any food to spare?
And I'm sitting there with my turkey and I guess this is when I realize why I'm supposed to love this city. I don't want to. But I'm supposed to. I'm supposed to love these people. Give them my time, my turkey, my all. I hope I'll slowly learn how to give more of me. Until then I'll just keep repeating it, I heart NY.

Compassion

One of my three new years resolutions this year was to blog weekly. Well...we see how well that's going. Great.
But I'm finally opening up this dusty blog of mine and digging deep to find an interesting tale to tell. There have been many hilarious, challenging, disappointing, and exhilarating things that have happened in the past 6 months. But I guess I'll just write what I'm thinking about tonight. And maybe that will spur me on to live up to that resolution this year.
I've been thinking a lot about compassion lately. First of all, what does it mean? So I googled it. "Compassion is a human emotion prompted by the pain of others"... "More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another's suffering"... "Do to others what you would have them do to you"... "The English noun, meaning to suffer together with". I've seen this word lived out in front of my eyes since I was born. My mother and father are two of the most compassionate physicians I have met. They would truly, honestly, rather a patient see wellness in their own life than see uninterrupted sleep or time for hobbies in their own. My childhood was spent watching my general surgeon mother tirelessly return pages to the hospital nursing staff about the needs of her patients. And I remember sitting at the dinner table, watching her every move as she would repeatedly get up and go to the phone to patiently answer questions, order medications, or pack up her purse and grab her keys once more to return to the hospital to give her time, her life, to one more hurting patient. And that is what I wanted to be. I'd often ride along beside my parents and jump out of the car and scamper along beside them into the ER and into the OR and wish and hope that maybe someday I could have the knowledge to help these hurting people as much as they were able to.
I proceeded to apply for medical school to make this hope a reality. And in my application for school I wrote of "compassion". I naively tossed around the term, making bold statements about my own character, that I saw myself as a compassionate person, with the potential to show service to my patients and colleagues during my career as a physician.
And now I am seven months into a surgical internship and I will tell you what I have learned. The most important thing I have learned. It is not how to tie a perfect surgical knot or how to resuscitate a patient in cardiac arrest. The most important thing I have learned is that I stupidly assumed that I had the required compassion to be a physician of kindness and healing. I'm currently working as an intern on the vascular surgery service. Basically what this means is that I care for the dying extremities of the people of the Bronx. At 5:30am today I unwrapped a gauze dressing from the foot of a morbidly obese diabetic man. I stooped down at the foot of his bed and removed the last layer of yellow tinged material and immediately breathed in the wretched stench of necrotic death. Half of his elephant sized foot had been amputated previously and the remaining half was bubbling was gaseous green pus. I followed the instructions of my chief resident, removing the dead skin, applying antibiotic ointment and gauze dressing once again. And with every layer I wrapped I became more angry. I began listing in my mind all the horrible, unfortunate things happening in my life at that exact moment. Why should I be subjected to this dead stench? Why should I have to be here at this ungodly hour? Why should I have to miss my family and friends so much? And all this for a patient who will almost certainly call me to his bed side in the middle of tonight to complain about his pain and refuse to be stuck one more time for the blood draws I will likely demand to obtain.
And tonight I'm thinking about these thoughts of mine. And I am embarrassed to say these are honest and true. Is this compassion? Is this the medicine I desired and delighted in? Is this the physician I wanted to become? Is this the treatment I would want "done unto myself"? Certainly not. I am embarrassed that I had assumed I had the compassion this profession required. But my eyes have been opened and I demand more of myself. I realize today that becoming a surgeon will require much more than learning to tie knots, it will require dying to my own desires in order to "suffer together with" my patients. It will require more of me. I will begin working on this. And praying for this.