Happyland, USA

It's always hard to imagine that places exist in which people simply live happier, but they do.  I mean, truly, deeply, genuinely happy.  It's downright enraging if you live in a place like New York, because it makes you feel like your anger is unnecessary, and New York is the sort of place in which anger is in your bones and leaching it out would make you weak, barely able to stand.  To be in a place that is happy is to imply that happiness, like melancholy, is a place one inhabits, can get stuck in and finally break free of.

Despite having just taking a vacation in June, I was scheduled for another for the second half of September.  I barely gave any thought to where I wanted to go or what I wanted to do, because the last vacation had been so recent and I really didn't need a mental break the way I did last time.  I toyed with the idea of hitting India or just bumming around home, when my best friend M suggested I see my friend C in California.  C, who I have known since I was twelve and is a member of my core girlfriends, basically left home at age 18 for college and simply never looked back.  She has done world tours on a shoestring (and now ties a sari better than I can), tracked tortoises in the Nevada desert, performed field research in the Galapagos and finally settled in Santa Barbara for grad school.  She is terribly clever, and quite simply one of the best and most patient people I know.  I hadn't seen her properly for about two years, with the exception of all-too-brief evenings together when she happened to come home.  She was only just in the process of setting up her SB arrangements when I asked her to come by and visit.  Needless to say, she was all over it.

The thing about California is that, despite the casualness which everyone tries to exude, it is a land of extremes.  As I write this, I am in an airport shuttle on a highway wisely nestled between steep, chopped hills and the rolling, foamy sea.  A mist has settled over us, masking the red sun, and giving the eerie illusion of a Maine november.  At every turn is Latin cuisine that makes you wonder why anybody in New York even attempts mole chicken, or wine that makes you drop $80 on a cross-country shipment without thinking twice.  The nerds at Lenovo throw a seriously wild party, the roads move at 85 mph without the slightest hint of impatience, and everywhere you turn, someone is bending over to extend you a courtesy that you didn't even ask for.  It is, as they say, easy living.

But, spending time here long enough, one wonders what the difference is.  Does it really boil down to year-long sunshine?  Temperate weather?  The knowledge that a hazy morning really will burn off into clear afternoon air, every single day?  In principle, I don't believe in running away as a method of resolving an issue, although I am a person who often feels the urge to run / turn her back / cut things off when she isn't happy.  But the more I travel, the more I wonder whether New York, with all its neuroses and dissatisfactions, is really the place for me.

Waterworld

I'm not sure if it's true in other parts of the country, but New York loves to hype up natural disasters.  This past winter, the various dumpings of snow led newscasters to label the winter storms with such monikers as "Snowgate" and "SNOWMAGEDDON!!!"  It led a lot of people to stop taking weather reports seriously, as well as the Fox News team in general.

Somehow, the dude upstairs had something else in mind this week, though.  Post-call last week, I woke up sometime in the afternoon to feel a rumbling.  I assumed it was the local freight train that comes through once or twice a day and gives my apartment a mild vibration, but when it intensified and became more irregular, I briefly woke up and thought to myself "Hmm, must be an earthquake.  Okay." and went back to sleep.  My first earthquake ever, and I missed it!!  It wasn't until a few hours later when I hit Facebook that I realized that the earth had moved from virginia to connecticut, with everyone else super-excited for The Great Quake of 2011.  (A guy in Brooklyn even had it tattooed on his arm.)  Of course, there was much mocking to be had - a number of pictures circulating "documenting" the destruction, which depicted a lawn patio table set with one plastic chair mildly knocked over.  Still, it was exciting.

That is, until the news team seized on Hurricane Irene, steaming up the Eastern Seaboard.  It was apparently the first hurricane to directly hit the NYC area in several decades, although I remember many summers of very intense thunderstorming and flooding because of the residual tropical storms coming from the Caribbean.  I've seen NYC panic before, but people began to act like the end of the world was approaching.  My friends all posted pictures of people lined outside the Trader Joe's, beating each other down for the last biodegradable container of wasabi peas, while my parents brought in the goldfish from the pond and stocked up on sandbags from Home Depot.  My own home base became a part of the mandatory evacuation zone, and so all 40 patients had to be removed from the facility, as well as a number of my co-residents who lived in the area as well.

But for me, it became an exciting chance to hole up and go back to basics.  My new boyfriend Z asked me to spend the weekend safely ensconced together, so I "evacuated" him from the Upper East Side and we drove together to Brooklyn, to spend it with his friends J&J, a fabulous couple about whom enough sweet things cannot be said, as well as his close friend S.  We hung out, ate pizza, watched Star Trek, played Settlers and Starcraft (I took a nap for that last part) and just had a million laughs.  Around 3 am, we went up to the roof to watch the hurricane kick into action, and as the wind blew the trees over and the rain poured sideways, I started to feel infused with an incredible awareness and connection to the force we were witnessing together, something I rarely feel since leaving the windy streets of Chicago.  We woke up the next morning to eat bagels, lazy around, and take bets on who would be able to escape their Monday morning responsibilities.  (I wasn't.)

Like the storm, I came into the weekend with an intense fever pitch and left in a calm, deeply contented state.  My neighborhood had a downed tree or two which smushed a few cars, but we were otherwise well for the wear.  The home base hospital still hadn't opened, but maintenance crewed and residents began trickling in.  Everyone showed up to work more or less in one piece, and we resumed the work of the day without a backwards thought.  Except for the occasional twig out of place, we had all moved on.      But in my head, I treasured having two whole days to feel gratefulness and even joy.

Death and Birth

It's been about a week and and a half, and my return to Shmeens has started a bit smoother than I expected.  Considering how tense and nasty everyone was acting the last time I was there, I clamped down and tried extra hard to be sweet to everyone I spoke to.  I encountered a nurse or two who I had gotten into throwdowns with, and thankfully they didn't remember me, so I was able to start over with them and act extra grateful (even if all they were doing was a basic task).  I would have tried to do this anyway, since I was scheduled to spend a lot of time at Shmeens, but I had a separate reason for doing so.

Without revealing too many details, it is looking a bit likely that my home base hospital may close.  Sadly, this is the story not just for our facility but for many many others in the metropolitan area.  It seems to be a clusterfuck of a situation, for lack of a better word, because all of the hospitals' debt is being called out at the same time that corruption in the governing hospital systems is being called out, at the same time that the state is unable to provide funding despite acknowledging a need for hospitals in underserved areas like ours.  There has been a lot of rallying on the part of the community and doctors and nurses to save our facility from a terrible fate, but I fear that it's just too late for what seems to be a done deal.

The kind of pall this sort of event throws on everyone, it's hard to describe.  When we first heard news (which wasn't even news), the nurses went into a super-chicken mode in which they basically screeched and clucked the news to anyone and everyone who would hear, even if there wasn't anything definitive to report.  There is so much sadness that everyone feels for the community residents, many of whom cannot seek medical help elsewhere because of economics and geography.  The attendings have all gallantly tried to roll up their sleeves to help, but of course must think of their families and so are quietly exploring jobs elsewhere.  Everyone agrees that it's a tragedy of Greek proportions.

This, of course, puts the residents in an uncomfortable position.  Because of the nature of residency programs and spots nationwide, when a program shuts down, residents don't lose their positions - they are typically redistributed to other programs (who happily take on the $150,000 value + resident labor) and the spot is later lost after the resident graduates.  In other words, while the hospital closing creates drama as far as where we will all go, we are not in the same boat as everyone else in terms of job security, and it's hard to look everyone in the eye when they're struggling and we aren't.  This is especially true of the surgical program, because our director is working hard to preserve the program itself as a living structure - to do this, we are trying to shift our home base to Shmeens.

We are very fortunate because we already were spending so much time at Shmeens, running their service and staffing their OR, that the program disseminating would be a massive blow to them.  Additionally, Shmeens once had a residency many years ago and lost it, and there has always been an interest to re-acquire one if possible.  All of our attendings there have been exceptionally supportive of the plan to relocate permanently, and seem excited to have us.  The chairman in particular has shown a lot of enthusiasm to further develop our program and utilize affiliations to create new outside rotations that we can add to our roster and boost our academic strength.  And fortunately, we already share one attending with the home base, to help ease the transition.

I'm not really sure of how I feel about it.  Or rather, I know how I feel, but then I'm overwhelmed by guilt about it.  Our program will have an easier transition by far than the other residencies at the home base, and they are still fighting to stay open.  One in particular will likely be split into two programs, a travesty because that program is quite coveted in the area because of the specialty it trains for.  On my part, I almost wish closure would happen as soon as possible so that we could all move on with Shmeens, but the reality of that would mean expediting the loss of nearly a thousand jobs in a relatively poor area.  Being at Shmeens where it feels safe, I'm taken away from the tragedy and heartbreak.  I don't want to go back.

I'm gonna, gonna lose my baby / so I always keep a bottle near

Amy Winehouse died today, aged 27.  I think it's pretty obvious that it was from her completely unchecked alcohol and drug addictions, but I'm sad nonetheless.  Music got me through a lot of the very low points of medical school, and Amy Winehouse's music really expressed much of how I felt.  I know that she was often falling down drunk at live performances, so I'm including a clip here to show that she really and truly was a talented girl who just couldn't get it together in the end.

Amy, sorry it didn't work out for you.  We'll miss your voice and your soul.

Today's "Oh, crap!" moment of the day is brought to you by justthetip.com

Monday night, 10 pm, on call.  While rounding in another part of the ICU, my intern gets a page that one of our post-op patients is desatting.  She desatted earlier in the day, but we got her back with aggressive suctioning, so my intern leaves to try this out.  2 minutes later, I walk in.

Me: Whoa, she's down to 78%?  That's worse than before... and her pressure's dropped!
Intern: Oh, yeah.
*my friend E, the medical resident on that evening, walks in with his intern*
Me: E!  Oh, thank god.  Listen, she desatted earlier but we got her back with suctioning.  I'm going to bump up her O2 and attach this ventimask while I suction her.  Wait, that's not a ventimask... do we have anything else?
Nurse: Can't you see that I'm BUSY?!  (Gets back on phone)
E: Ok, let's get a second O2 sat monitor, this thing is jumping around and I'm not sure if it's working.
Me: Great idea.  Hmm, this really isn't getting better.  I'm going to sit her up.
Intern: She's only satting 60% now, on this new machine.  And her pulse just dropped to 50.
E: *listening to chest* Nurse, page respiratory - we need a proper mask.  She's not getting adequate ventilation here.
Me: *nearly hysterical* Holy shit, her sat's now 50%.
E: *silent*
Me: *silent*
Us: *simultaneous realization that two 2nd year residents are in charge and nobody more senior is coming to help us*  Uhhhhhhh.....
*300 years pass*
Respiratory: Did someone page respiratory?
Us: OH THANK GOD YES SHE NEEDS TO BE INTUBATED RIGHT THIS VERY SECOND OH GOD OH GOD OH GOD!!!
Respiratory: Ok.  Move.  *Intubates*
Me: Mrs. Jones?  Can you hear me?
Mrs. Jones: *big smile*
Sarada's Ass: Wow, I don't think I'm going to be able to pass stool for days now.

Samaritan Woes

I think it's pretty reasonable that, after awhile of training in medicine, a person starts to imagine scenarios where they get called in to serve.  Usually it's the airplane scene, where someone starts to have chest pain at 30,000 feet and the airline hostess gets on the intercom and says something like "Is there a doctor aboard?" or similar nonsense.  Most practicing physicians say they really dread these kinds of situations, because of the lack of equipment needed and lack of control over the situation.  (Not to mention, the extreme obligation it places on the physician who is escaping an insanely busy practice to get just a few days away with the family.)

It never occurred to me that there would also be an extreme sensation of terror upon getting involved with this type of scenario.

Last night, after lazily laying about all day and watching Hindi movies on Hulu, I got dolled up to meet a girlfriend for dinner and drinks.  I was already running late when I got out of the subway in the West Village and was walking briskly along when I saw a crowd of twenty people surrounding a body lying on the sidewalk outside a shop.  Getting nervous, I asked one of the women standing there what happened, and she said that they just saw this guy lying there and someone had called EMS.  I asked if anyone had checked him to make sure he had a pulse and was breathing, and she said no.

My heart dropped out of my chest.

"Are you kidding me?" was really all I could say.  I crouched down next to the guy, put my purse down next to me, and started getting my hands all over him to look for a pulse, breath sounds, responsiveness, anything.  Another woman asked me if I was a doctor.  "Oh shit," I thought to myself with increasing horror, "I am.  Oh, god."  I realized in a moment of further panic that I didn't even have a stethoscope, and just put my ear to his chest to see if his breathing was appropriate or junky.  I got lucky - he wasn't tachypneic or tachycardic, and sounded pretty clear - he seemed to really have just passed out.

He suddenly got up, and it became apparent that this guy was chronically intoxicated.  We sat him in a chair and I pulled off his hat to check for signs of head trauma, as he reached into his pocket to roll a cigarette (or "cigarette").  He was oriented but clearly confused, as he told me that he had simply tripped going down a few steps into the shop (but somehow fell on his back, above the staircase).  EMS showed up and pulled on some gloves before touching him, and a creeping grossness overcame me as I ran to the bathroom to wash my hands and arms, and soak a paper towel in rubbing alcohol to clean off my left ear as I tried hard not to think about scabies.

My friend showed up on the sidewalk, in the meantime, with a shocked look on her face as I came out of the store looking as though the world had just ended.  We walked away, while EMS tried to coax the guy into their truck so they could take his vitals, and went about our dinner plans.

On the way out of the last bar of the night, we passed an EMS team evaluating a young man completely passed out in front of a garden apartment.  I kept walking.

PGY-2

Things I have learned during my first week of being a 2nd year surgical resident:

1) Having an intern is like having a kid.  I'm just so anxious for how well they're doing.  I stay awake just thinking about it.

2) My residents were actually snooping behind my back when I was an intern and checking charts and stuff!!  No wonder they could always tell when I was lying.

3) Being a resident makes you feel POWERFUL.  Until someone asks you to do something and you remember that you don't know squat.

4) ...but the title sure does count for a lot, as snoop dogg intern points out (from 1:05)