Fortune Cookies

Last night I went to a Chinese restaurant with the Mix family. My fortune said,

Your mind is ingenious and you learn easily.

Is it just me or are these cookies getting more and more accurate?

Christmas

As I have been reflecting on Christmas a phrase Kay Arthur said while we were in Israel keeps coming to my mind,

In the House of Bread (the literal interpretation of Bethlehem is "House of Bread") the Bread of Life was born and laid in a feeding trough as an offering to the world.

Ice Ice Baby

Tuesday night was one of the craziest nights of the year for me. There was a massive ice storm in Indy and I was on trauma call. Police responded to 888 accidents in Indianapolis and 14 ambulances were involved in accidents getting to the other accidents. They had to use fire trucks to transport patients to the hospital. To say that the night was busy would be an understatement.

In addition, I am on a string of trauma call every other day. It is pretty rough. I am in the hospital for 30 of every 48 hours for a week straight, including all of Christmas day.

There are two bright spots to this whole ordeal:

1. My wonderful family braved the weather and came to spend Christmas eve in Indy with me. We saw The Lion King musical which was amazing and went out to dinner with Arch and Connie. Of course we enjoyed watching ND destroy Hawaii.
   
2. Next week I am on vacation. I've got big plans for the week and it is going to be wonderful. New Year's Eve is going to be crazy fun!
   

The Animals

Tonight I went with Shawn and Paul, two good friends from my house church, to Christmas at the Zoo. I was chosen to participate in the holiday dolphin show which was fun. I got to give the signals to the dolphins. We petted the sharks as well. I know I should avoid that until I get more disability insurance but who can resist the slimy creatures. It was freezing outside (2 degrees actually) but I love being outdoors with good friends at Christmastime.

We Like to Party

Surgeons know how to party in style. We had our annual Christmas party at the top of the OneAmerica building in downtown Indy. I, with my good luck, won a giftcard to Maggiano's (my favorite Italian restaurant) for $50. A few of us went out for a fancy dinner beforehand and then walked through downtown's Christmas displays to the party. All-in-all it was a really fun night!

Quotationary

I love quotes and my wonderful friend Tara Mix gave me a book called the "Quotationary". With the freezing weather and dark evening tonight I am lacking motivation to study or do anything other than be lazy(hence the surge of blogging) and I looked up enthusiasm. This quote by Samuel Taylor Coleridge has helped urge me to study,

Nothing great was ever achieved without enthusiasm.

In less than 2 months I take my first ABSITE exam (American Board of Surgery In-Training Exam). Yes, it is kind of like what George O'malley on Grey's Anatomy failed. It is a pretty big deal and my chief resident over the weekend urged me to take it very seriously. I have been casually studying for a month or two already, but need to pick up the pace. So, thanks Tara for the great quote to get me to study tonight instead of watching "You Don't Mess With the Zohan" in my heated bed.

I've got an ice-cold Diet Coke and a 2300 page textbook (a real page-turner) on my desk. Let the fun begin!

My Life is Ridiculous

Sunday morning I came home after a long night of mending people from their stabbing and gunshot wounds (not really-I mostly do paperwork in the big traumas- next year I get to do more of the fun stuff). I was excited to clean up and take a quick nap before exercising and watching my Colts play (yes, they are my Colts. I even have temporary tatoos with their logo on them- thanks mom). As soon as I entered the house I heard this annoying chirp every 20-30 seconds. I assumed my fire alarm battery was dead which annoyed me because I just replaced it a few months ago and it was supposed to keep working like the energizer bunny. After pulling my battery out the noise didn't stop. Eventually I traced the source to a carbon monoxide detector in my house. This concerned me and it told me to move the alarm to an area with higher air flow which I did to no avail. Since I am compulsive I have a second alarm which I checked. It told me (or I thought it was saying) that my carbon monoxide level was between 254-256. If you know anything about this (which I didn't beforehand) this is a very high level.

At this point I was wandering around my house trying to figure out what to do. I was laughing and pondering how I get into such predicaments. I figured I had a little time to investigate so I booted up my computer to figure out if 256 was high, called the gas company, called the alarm company and everyone told me to call the fire department. I thought this was a little much but I really had no other option. They instructed me to wait outside and within 2 minutes I heard the sirens. It was a ridiculous scene with lights and sirens and 4 men on their large truck to bring a little handheld machine into my house and get an accurate reading. I must have apologized 10 times for the nuisance although I pointed out that I was considerate enough to do this before Colt's kickoff.

In the end they deemed my house safe to live in, taught me how to use my alarms (I'm a doctor not an engineer or computer science wizard), marveled at my beautiful road bike and trainer, tracked snow in my house, and suggested I get the furnace fixer man out to the house since the level is a little elevated beyond what could be excused by car exhaust and other randomness. Seriously, those alarms make no sense. I tried to read the manual before calling them to make sure I wasn't mistaken, but it is in a secret code. They laughed when they saw my manual and said it would have been ironic had I been found passed out on my couch with the manual in my hand.

All in all I now know all about carbon monoxide and am glad I have 2 alarms. I am comforted in the prompt response from the fire department which is 2 blocks from my house. If you don't have a detector go get one...or two!

What I've learned in residency

Here are a few of the more interesting concepts I have gleaned from residency:

• Don't mind your own business. Everyone who gets shot or stabbed was just minding their own business. Seriously it's not safe.
  
• Watch out for handicap doors. There might have been a visitor coming to see a loved one in a bad accident who got hit by a handicap door, broke their hip, and had to have emergency surgery due to the internal bleeding. If it weren't for bad luck some people wouldn't have any luck.
• Don't try to jump onto a moving train. You won't be pleased with the outcome.
• Don't run away from a K9. Seriously, they will destroy you. I've seen the results. They're not a cute puppy, they are a dog trained to tear you to shreds and that is precisely what they do.
• More shots doesn't guarantee that you will kill someone. In one night one person was shot over 20 times in the chest, abdomen and pelvis and lived while another was shot once in the arm and was dead within minutes. It's a crazy world.
• Don't wait 5 weeks to come to the hospital if you haven't had a bowel movement. That's just crazy.
• If you truly believe a criminal placed a silicone implant in your belly don't try and cut it out, just calmly make your way to the hospital and we will straighten things out.
• Swallowing sporks is just stupid. Period.
• If you want to get out of prison swallow everything in sight. It will not only be amusing but will win you a surgery,narcotics and a cute nurse to wait on you. Do this more than once and it isn't amusing any more it is just annoying and a massive waste of taxpayer money.
• If you swear at the doctors trying to help you it won't win you better care.
• Calling 911 to get an ambulance to bring you to the hospital for a pregnancy test really does happen. What a broken system we have!

Demotivators

There is a website called Despair.com. If you haven't been there before you need to go. It is hilarious. It is the opposite of Successories and every once in a while I go there for a good laugh. Here are a few of my favorites:
Government: If you think the problems we create are bad, just wait until you see our solutions.


Mistakes: It could be that the purpose of your life is only to serve as a warning to others.


Tradition: Just because you've always done it that way doesn't mean it's not incredibly stupid.


Achievement: You can do anything you set your mind to when you have vision, determination, and an endless supply of expendable labor.


Incompetence: When you earnestly believe you can compensate for a lack of skill by doubling your efforts, there's no end to what you can't do.

The reason for it all

Right now I'm on a stretch of being on call every other night. It's fairly brutal and so I'm taking a little time tonight to remind myself of why I am doing this. These are pictures of people I met in India who, unless things change, have no access to surgery care. Something as readily treatable as an appendicitis could be fatal for them. We are blessed to be a blessing and I cannot wait for the opportunity to operate overseas!

Be Warned

This is a bumper sticker that my mom just showed me. I'm sorry if it offends you, but I think it is hilarious. Our country is something else. President-elect Obama has my complete support if for no other reason than he needs it. Whether you voted for him or not you might as well get behind him because he will be leading our nation for the next 4 years.

I won't be purchasing one of these bumper stickers, but I am once again entertained by the political humor.

Grey's Anatomy

I am a shameless fan of Grey's Anatomy. While some of the recent subplots have not been my favorite, something about the show keeps me watching. One of the questions I get asked fairly regularly is how similar the show is to real life. Let me just start by saying even I am amazed at how accurate it is. Here are some examples:

- The residents really are becoming some of my closest friends because they are the only people who know what it is like to be on call and have a patient coding and it is up to you to keep them alive through the night.


- We practice on animals. Like it or not it is a reality in medicine and no computer can replace animals. We do a lot on computers as well, but some things just have to be done on real flesh. A couple of weeks ago on the show they practiced on pigs which is very commonly done- especially in trauma situations. We also practice on bodies donated to science. We do have a computer patient who talks, bleeds and everything else and I think his name is also Stan.

-We take the yearly ABSITE- American Board of Surgery In-Training Exam. It is in January and I am starting to study for it now. Failing the exam one year doesn't set you back a year like it did for George, but you have to do certain steps to remediate.

-The unique romantic relationships on the show isn't very common but it does happen.

-Staff yell at residents regularly. Miraculously, very little of this has been directed at me (probably because the expectations for an intern are pretty low), but my day will come. I have witnessed many very nasty interactions of this sort.

-We do have a weekly morbidity and mortality conference where you have to answer for mistakes made. The highest level resident on the service does the presentations and then the staff speaks up.

-The level of intensity on the show is real. There are times of calm and fun, but there are a lot of times very serious and pressure-filled.

-We do occasionally have a patient light a cigarette in the ICU while they are receiving supplemental oxygen. It's crazy and insanely dangerous, but I've been around when a nurse caught a patient light up.


Here are some ways where things are a little (or a lot) different:

-No one has held a grenade inside a human body before

-We haven't raised a resident from the dead after a drowning

-No one has stolen a real heart.

-We don't all go to the bars after a day at work. We do sometimes, but not everyday.

-We don't compete over patients or surgeries. At times it is actually quite the opposite- it is referred to as punting a patient to another service. We have teams which a patient is assigned to and the chief resident of that team assigns different residents to different surgeries.

-Thankfully the interns are not treated anywhere near as badly as they are on the show. We get to operate and have positive interactions with the upper level residents.

-We are on call way more than the show lets on.

-We don't just scrub in for a case to watch staff operate. Sometimes as an intern I go into a case if I have time just to watch something I haven't seen before, but we're learning how to operate and when we scrub in we are almost always actively participating.

-We're done rounding by 7:30am.

-While I feel comfortable joking around with most staff there is no way I would yell at them or get in their face about the way things were going.

-We don't sit around watching dermatologist's get facials and hand massages. If we saw it happen though we would gawk just like they did on the show. I can't say I've ever seen a dermatology resident in the hospital.

-We get along with most other residents in the hospital. There are a few specialties who are notorious for certain frustrating situations but a lot of the residents were our classmates in med school and we work together well.

-We have lives outside of medicine. We don't all live together and spend every bit of our free time together. We like having friends who aren't in medicine.


I'm sure there are a lot of other similarities and differences, but these are all I could come up with for now.

Politics

I seriously love to vote. Every time I enter the polling area I am thoughtful of the research I've done and why I am voting for the candidates I chose. It is a serious moment of reflection on the democratic process where I think, "I'm proud to be an American". However, as I am filling out my ballot and turning it in I get this urge to start screaming and shouting and trash-talking for my candidate. I think it is too many years of competitive sports as a child or something but today it was all I could do to calmly walk by those still campaigning for the other candidate without letting out a big cheer for those I'm supporting. I'm going to a results party tonight where maybe I can get some of my political energy out.

I came home and watched last night's SNL Presidential Bash online in honor of the day. Political humor might be my new favorite kind. There is nothing like watching the real McCain pretending to sell knives on QVC to get a good laugh. Here are my 2 favorite SNL skits from the many of the past few months:

Joshua Tree

Upon the high recommendation of a fellow intern we eagerly trekked to Joshua Tree National Park for a day. It was well worth it! It was nothing like I expected, but we got to climb around on some pretty large rocks. We eventually (after quite a bit of dialogue over what this tree was) made the connection that the tree we kept seeing all around us was actually a Joshua tree. We are very bright individuals. The park is a mecca of sorts for rock-climbers, but due to my parent's (and everyone else I mentioned the idea to) concern for our safety we didn't attempt any real climbing. For the record, I want to someday.

Horrible Hiking

I just got back from a wonderful week in Palm Springs, California. It was sunny everyday, warm but not too hot, and beautiful. Heather was with me for the first part and we did all sorts of fun things but this post will be dedicated to my least favorite part of the trip.


The first day we did this horrible hike. It seemed like a good idea and started out ok. I was concerned about my water supply but didn't anticipate the hike being too long or strenuous. Plus we were told there were 2 places to refill our water supply. In actuality there was one and they said the water needed to be filtered. So I didn't want to be sick for the remainder of the trip so I went 12 miles (6 up the mountain) in 5 hours or so with 27 meager ounces of water. Rationing was the key. Afterwards we went to DQ and I chugged a ton of water and enjoyed a peanut buster parfait. I had a mild headache due to the dehydration. After eating I quickly became nauseous and before I knew it was throwing up everything. It was pretty impressive. Peanuts were lodged in my nostrils. It was some kind of spectacle which Heather missed out on since she went to scope out the pool while I "rested". Thankfully after that I felt fine and enjoyed the rest of the trip. Heather has the pictures from this event so you'll just have to use your imagination. It was a beautiful view from the 2nd highest mountain in Southern California.
Just for the fun of it here are some of the windmill generator things around where we stayed.

The Shack

I just read this book in the past few days. I found it hard to put down because it truly challenged my perspective on tragedy, the reality of God, and how God works through tragedy. Of course it needs to be read as fiction, but I think there are some figurative truths that it makes easier to grasp. Is it the Bible? No, but it conveys some unique aspects of God in a way that is thought-provoking. I would recommend it to anyone and everyone! This quote at the end sums it up,

Earth's crammed with heaven,
And every common bush afire with God,
But only He who sees takes off his shoes;
The rest sit round it and pick blackberries.

-Elizabeth Barrett Browning

Oh that we would have eyes to see!

Story Side B- Be Still

I heard this song yesterday and love it. Enjoy!

Insomnia

I can't sleep right now. I'm on call and have been for 60 of the last 72 or so hours. Despite the relative sleep deprivation I am unable to even consider lying down because I am so energized by taking care of patients. It's crazy. I LOVE what I am doing. Being a doctor is pretty much the most incredible privilege. Some wise person said, "Do what you need to do so someday you can do what you want to do." I have thought about that often through college and medical school and I am much closer to the end goal and it is much better than I could have imagined.

Tonight I discussed "code status" with a family whose mom is likely to die tonight. I get to spend the night walking through this with them. What an honor! After speaking with them the well-experienced nurse gave me a hug and said, "Once again you are my hero." I said, "Why?". She said, "I just love the way you do business. You have a really great way of relating to patients." I don't rely on the affirmation of those around me, but it is really encouraging and energizing to be reminded that I am doing exactly what I was made to do.

While I wouldn't mind getting some sleep tonight after a very long week, I know that in 5 days I will be flying to Palm Springs, CA for a week of fun and rest. So tonight I will lean in and help this family walk through one of their darkest nights.

What do you need to do so you can do what you want to do? I've still got a long way to go to be a staff surgeon able to go abroad and teach others, but I'm taking steps and know that that day will come much faster than I expect.

Voices

I'm sitting in one of the call rooms (no, this doesn't happen often it's just a very slow day)at the hospital thinking over the weekend. I am blessed to have some incredible mentors speaking into my life and in the past week I have interacted with all of them. These aren't the only people I listen to, but their words to me have increased weight because of the respect and admiration I have for them.

Sarah Kolasa Bouma formally mentored me in my last year of high school and through college. She walked with me through the hardest period in my short life and alongside God, counselors, family and friends helped me come out much stronger and more balanced. She called me to be a great leader and helped develop some early leadership gifts in my life. I have always looked up to her and consider her friendship to be an incredible blessing in my life. She might be the only friend who shares my appreciation for Dumb and Dumber and Night at the Roxbury.

Michelle Wegner is someone I have looked up to since middle school when I first met her. She has always been one to challenge and encourage me and in the past year we've taken that up a notch. I am so thankful that she takes time out of her busy schedule to email and get together to talk. I love hearing about her life, her incredible marriage and family, books she is reading, and her vision for what we can do to take the Kingdom of God all over the world.

Arch and Connie Nevins are the leaders of our House Church. They lead our group with love and wisdom. They are a blast to hang out with and it is phenomenal to dive deeper alongside them. I am so blessed to get to share life with them. Arch is writing a book that I can't wait to read. I'll let you know when it is available.

Dr. P is a surgeon who has been very intentional about mentoring me. He actually paged me one afternoon after I was done working on his service to ask if he could mentor me. It wasn't a hard decision. He's one of the leaders of the trauma/critical care program and he sees something in me that he wants to develop and help guide. He's a great man who treats me to good food and is helping plan my career.

Alison is a surgeon I connected with this year who is teaching me the ins and outs of surviving and thriving in a surgical residency. She has helped me work on my technical skills, patient management, presenting at M&Ms, and has also been a great model for blending marriage/motherhood and a surgical career (I'm not married or pregnant, just aware that someday I might be). A week into working together she said, "look I'm mentoring you whether you like it or not...". It was pretty funny.

There are many other individuals who have spoken into my life in ways I will never forget. I feel so honored to have friends and mentors to share life with. I wish I was mentoring someone formally but for now I spend a few focused weeks at a time with medical students. It is a great opportunity to get to know them, challenge them, encourage them, and model what a caring surgeon can look like. Who is your mentor? Who are you mentoring?

A quick update

Just wanted to check in and let everyone know that I am still not only alive, but doing really well. Residency is insane. There are times when I just walk around the hospital laughing at the obsurdity of everything. Here are some of the highpoints/lowpoints that are so awkward I can't not tell them:

• After operating with a surgeon I hadn't previously worked with he stopped and shook my hand and said, "welcome to the team". I didn't realize this but apparently he is really critical and tends to yell and swear a lot. He never even appeared remotely upset or bothered by me. Of course he gave me pointers but I made every cut, threw every stitch, and tied every knot myself. As I walked out of the OR I smiled and said a quiet, "booyah".
  
• When finishing my transplant rotation the secretary on the organ transplant unit gave me a huge hug. They kept telling me that they weren't going to let me leave the rotation because they're not used to residents actually enjoying the rotation and having fun with them. I tried to get them to organize a flag football game for the unit. They're hoping I go into transplant surgery and become the fellow for 2 years.
  
• One day I was rounding with the nation's leading transplant surgeon (in quantity and outcomes) for a certain organ and he mentioned a certain study and I was miraculously familiar with it and was able to discuss it intelligently (it just might be the only study I could have talked about). He said, " I can't believe you have even heard of that trial. It is incredible that you are able to have a conversation about it." I told him I was seriously considering transplant surgery and he exclaimed, "That would be great. I would really like that." It's good to have allies in the field you are considering pursuing!
• A resident pulled me aside at the end of my transplant rotation and said, "I know you feel abused and like they are giving you too much responsibility but you should take it as a huge complement. They are doing it because they trust you. Look at you, you are rounding by yourself on all of these patients in the ICU and writing orders while the other intern literally isn't allowed in the ICU unless he is with another resident. You are an awesome intern."
• While on call (about 25 hours into the shift) a nurse paged me and said, "I think this patient's trach (tube in the neck to help with breathing) fell out." I said, "What makes you think that?" She said, "I walked into the room and it was lying on his belly." This is the point where I wanted to joke around and say, "You think it fell out? If it's on his chest it's not in his neck-of course it is out." Instead since it was an emergency and she didn't know me enough to appreciate my sarcasm I just hung up and ran to the room to find a morbidly obese (around 500lbs) man lying there with a hole in his neck. If only you could have seen the rest. Trust me this job is really glamorous. FYI- he's ok now.
  
• I was told I needed to mark the site (write "yes" on the area of the body we were going to operate on) on a kidney donor and since I had no idea where specifically they make their incisions in that surgery I just put a large "yes" on the proper side and she freaked out. It wasn't where she thought the incision would be and I told her that I wasn't sure where the incision would be made. At that point she lost all confidence in our surgery team and was seeming to regret her decision to give up a kidney. It was a hilariously awkward situation where I tried to convince her that indeed I would not be the one cutting on her, I was just making a vague marking to get the right side of the body. In the end we got the kidney and so far it is working well. It is experiences like these that keep me very humble and remind me of how much I have to learn.
  
  

I am considering transplant as a career. Regardless what is becoming clear is that I do best with critically ill patients. I find myself naturally migrating to the ICUs and that is where I am most comfortable. Who knows what the future holds, but I'm getting more excited to pick a field and pursue it all out!
P.S. if you find yourself needing a liver, kidney, pancreas, small intestine, or stomach I would recommend IU very highly! They are one of the top programs in the country. People come from all over the world to have transplants done here. Who knew???

Meet Mbali

I wish I had a picture to show you, but I don't. However, Mbali is a beautiful 3 year old girl in Swaziland that I am sponsoring through World Vision. She lives in a country where 26.1% of the population has HIV/AIDS- the highest prevalence in the world. Her birthday is the same as two of my closest friends- October 1st. She turns four this year and is already responsible for carrying clean water for their family every day. She lives with her parents and two sisters. Her dad works in construction and is not surprisingly struggling to provide for their family. My $35/month will provide her with clean water, food, healthcare, education, clothing and other basic necessities.

Why did I decide to sponsor a child? Because children matter to God and I believe the HIV/AIDS crisis is breaking the heart of God. We are blessed to be a blessing and while I am a tad bit busy with residency, I can't ignore the extreme disparity between what I have and all that so many lack. I long for the day when I can go and operate on the sick and provide them with healthcare that they otherwise wouldn't have, but in the mean time I have to do something. Maybe I can even meet Mbali next time I travel to southern Africa.

Why World Vision? 86% of the money I give goes directly towards those in need. Their overhead is very small compared to many nonprofit organizations. They also give the option of sponsoring children in conflict areas (Columbia, Uganda...), areas with extreme health crises, children being exploited, etc.... Children all over the world have extreme needs, but my greatest interest is in those areas with rampant health crises.

Why Swaziland? I knew they had the highest HIV/AIDS prevalence and that sealed the deal.

It's fun to have an income and to be creative with other ways I can leverage my resources for bigger purposes. Mostly, I'm planning to pay off loans, but it's exciting to have some discretionary funds for other causes!

The question, "Is our community and world any different because our Church exists?" has been banging around in my head quite a bit. I'm still processing, but more and more convinced that if I'm not intentional about this the answer will be "no".

We are blessed to be a blessing. Who are you blessing?

Just another day

Here is a typical day in my life as a surgery intern on call:
Get to the hospital by 5 or 6am (sometimes 4am depending on the service)
Round on all of our patients with residents/fellows/med students- for us right now we have 23 patients, most of whom are critically ill so this takes a couple of hours
Meet with attending to round again
Write orders on all patients, schedule tests and procedures, contact consultants and discuss plans
Go to OR (this isn't happening much yet for me, but it will on other rotations)
Inhale food
See patients, follow up on tests, write more orders
Go back to OR
Admit new patients to hospital
Meet with intern from every other surgical service when they go home to get my "to-do list" from them on their patients
Answer unending pages (literally 100-200/night) from trivial questions to emergencies
Do post-op checks on everyone's patients
Admit new patients
Put out fires/crises
Eat
See more new patients
Try and lay down for a bit- get interrupted by a page every 5-15 minutes
Get up and talk with every other intern when they show up in the morning to tell them what I did with their patients overnight
Go see all of my patients again
Round with other residents/fellows on my team
Go to morbidity and mortality conference and resident education hours
Round with our attending
Write orders, call consultants, ensure tests and procedures are still happening
Take sutures out of patients, pull drains and tubes
Go home after 32 nearly non-stop hours
Go for a long bike ride to unwind- still answering pages while biking down the road
Continue to get pages every hour for the rest of the day
Go to sleep early to start it all over again the next day

It's been pretty wild, but I love what I am doing!

Courage

I'm studying Joshua right now and used the Quotationary that Tara gave me to find some neat quotes on courage:

Courage is contagious. When a brave man takes a stand, the spines of others are often stiffened. Billy Graham

Few persons have courage to appear as good as they really are. J.C. Hare

Life shrinks or expands in proportion to one's courage. Anais Nin

I would define true courage to be a perfect sensibility of the measure of danger, and a mental willingness to incur it. William Tecumseh Sherman

Courage is resistance to fear, mastery of fear- not absence of fear. Mark Twain

What does courage mean in my daily life right now?

Being an advocate for others when it isn't the popular thing to do. Taking the high road when I want to fight back. Submitting to the authority over me. Stepping up to new challenges instead of leaving them for others more experienced and confident. Working with excellence- not holding back from my potential. Calling out the good in others and not allowing them to shrink back.

What does courage mean for you?

Voices

Recently I heard someone ask, "Who are you going to allow to speak into your life?". It's a privilege to have a voice of influence in someone's life and I am learning to carefully screen those who are speaking into my life. Working with surgeons who are brash and quick to put others down I am quickly working on filtering out a lot of negativity. It's not that I am doing a horrible job or that the negativity is always directed at me, but it influences me if I allow it. So here are a few of the voices I am choosing to listen to:

• My parents- they love me, they love Jesus and they want what is best for me.
  
• My inner circles of friends- they know me as well as anyone and their words are like a breath of fresh air.
  
• My mentors- they are an unbelievable blessing and I'll have much more to say on them later
• My house church- this is a group of men and women I am privileged to share life with whom I respect deeply and treasure more and more.
• A myriad of other friends and relatives that I share a unique connection with

So who is speaking into your life? Do they deserve the privilege? Whose life are you speaking into? Are you honoring that privilege?

TriIndy

Well I survived the triathlon on Sunday. There were over 900 participants. I did the olympic distance which is a 1500m swim, 40km bike and 10km run. I actually came in 9th for my age group which I was thrilled about. I finished faster than my goal time and as a result I can hardly walk.

• The swim in the canal was fun in that miserable "when is this going to end" sense. It took me 35 minutes to swim the 1500 meters ( plus another several hundred meters from all of my zigzagging from one side of the canal to the other). Yes, the water was nasty, but no more than lake water. The picture might give the appearance that I had the canal to myself and it seemed like I did for part of the race but I dealt with plenty of people swimming on top of me.
  
• The bike was my strongest leg by far. I averaged 18.6 mph and felt like I could have gone faster.
  
• The run was painful since I didn't train for it at all. I averaged 9 minutes/mile with the frequent stops for gatorade so I was pleased with that.

Overall it took me 2 hours and 55 minutes. I am really glad I did the triathlon. It was much more enjoyable than the first one I did! My goal is to do at least one per year to keep me motivated during my workouts. Maybe I'll aim to win a trophy next year. Goals really do help me push myself harder and farther than I otherwise would.

Things I'm Excited About

1. A deep-fried Snickers at the State Fair tomorrow
2. My new Bosch dishwasher- it really is that amazing. In fact it is so incredible that I can't even hear it running right now.
3. The Olympics. Seriously I love them. I just wish I could watch more than a few minutes/day of them.
   
4. Having survived my first appearance at Morbidity and Mortality conference unscathed and apparently seeming quite calm and confident (although I was shaking like crazy on the inside)
5. Swimming in the canal in Indy this weekend during the TriIndy triathlon I am participating in
6. Mom coming this weekend. Not only will she cheer me on at the triathlon but she will bring good Michigan peaches and will help me with curtain selections for my house- plus she's just fun to hang out with.
   
7. Actually becoming friends with some nurses on the Organ Transplant unit
8. Some relationships that are molding and refining me (more to come later)
   
9. Sleep. I'm going to bed now. Have a great night!
   

Fastest and Shortest Trip

Today I went with a transplant surgeon on an organ procurement. After we finished a prior surgery we hustled off to the airport where a team was waiting for us. We immediately jumped on a waiting jet, quickly taxied and took off without a second of delay. It was crazy. I felt like I was traveling with the President or something because everything stopped for us to come through. When we arrived we were quickly taken straight to the hospital and were escorted to the OR where we got the organs. I won't say anything about what we took or the situation in which the organs were available but let me just say it was incredible! The transplant surgeon and I worked together to get everything done. The atmosphere was professional and respectful. As soon as we had what we needed we were whisked back to the airport and immediately took off. The jet was amazing, they had great food for us, and I was able to learn a lot about the ins and outs of the transplant world. All in all it was an incredible day. I'm not saying I'm going to become a transplant surgeon, but I am an organ donor and I think everyone should be. One life was lost today but several were saved.

Great Quote

I have a book that I write down quotes that inspire me from time to time. I was looking through it today and came across this one by Dr. Crawford Loritts that sums up my feelings on life right now:

You are never to be held hostage in life based on what you don't have. It is who you have and His calling on your life that determines what you do. It is not always due to your giftings, talents, abilities, and personality. When Paul said, "Now to Him who is able to do immeasurably more than we could ever ask or imagine," it is as if Paul is grabbing the Church in Ephesus by the lapels and saying, ' You have got to believe that you have a big God.' You must believe that.

Highlights of being a surgeon for a month

• Listening to "Viva La Vida" while operating for the first time and then singing it to my team for the rest of the day. They really appreciated it.
  
• Having my attending tell me that the skin graft I did was the best he had seen in years
• Working with a fellow who has made it clear that she wants to mentor me long term. She has been an incredible blessing as she has taught me a ton in an environment that is safe and edifying.
  
• Saving a life. Yeah there's nothing like it and I feel comfortable saying that I've done this several times. Sure someone else would have done it had they been there, but I was and it was incredible.
  
• Seeing the parents of a young girl who I resuscitated afterwards and seeing their gratitude. It was pretty incredible to walk with them through what were the scariest hours of their lives. They threw the "f bomb" at me in the heat of the moment but redeemed themselves afterwards. I can't blame them. It was a really bad situation, but she is 100% better now.
  
• Having a nurse approach me to tell me that all of the nurses have really good things to say about me. It is really important to me to get along well with other hospital staff and sometimes as a female physician it is a little more challenging. So far so good I guess.
  
• Working with colleagues that already are or are becoming my friends
  

One Week

I have one week left in the ICU and my feelings are mixed about it. I love the fellow (someone who has finished residency and is doing further training) I am working with- she is a great role model, she thrives on teaching, and she is fun to joke around with. My attending is an intern's dream. He is nice, patient, and trusting just enough to let me safely learn and gain experience. The patients are incredibly sick and so I am forced to learn a lot...quickly.

Daily I am thrust into situations where I am the leader- running a code, holding family meetings, discussing end-of-life issues...that aren't as prevalent on other services. On the other hand, being on call is ridiculous. I'm sure it will be just as busy on most other rotations, but hopefully more giving tylenol and anti-nausea medicines and less of the actively dying issues. It's a lot for an intern to handle. It's a good thing that there are tons of people there to help. It is amazing to see how many patients actually get better. I see miracles happen every day.

Things aren't going to be easier next month since I'm doing transplant surgery for the third largest transplant program in the country. It should be full of unique challenges and learning opportunities.

I couldn't be happier about how residency has started. I am at the absolute best program for me, surrounded by friends as colleagues, working with attending physicians who are teaching and encouraging me, with a phenomenal relationship network keeping me sane.

I am so thankful that God knows what we need and what is best for us long before we are able to see the big picture. How great is our God!

Tires

I went to the Brickyard race today with a friend. I thought it would be really fun to stare at mullets and watch cars zoom by. Instead I only saw one mullet (everyone had hats on) and cars were moving slowly thanks to all the yellow flags resulting from the tire problem. What in the world was wrong with the tires??? I thought the race would never end. I actually texted a friend to find out how many laps the race would drag on for. I fell asleep through a few cautions-although I will blame that mostly on having been on call Friday night and arriving at the hospital at 4:30 am today.

Anyways, I am usually up for trying things once and I am glad I went. I still don't understand the Nascar phenomenon. You can hardly see the cars when they are racing, you sit in the heat for hours, and the traffic is insane afterwards.

I was sitting across from Jimmie Johnson's and the other top driver's pits so it was fun to watch their many many pit stops. The strategy the Johnson crew had at the end seems to be what won the race for them.

The best part was watching (and listening) to the crowd go nuts with every yellow flag that was waved.

I'm glad I went. I love trying new things. You should experience it for yourself at least once. It's a different world...

Quote of the Day

Someday I want to be this confident in my surgical skills:

Lance Armstrong asked Dr. Shapiro ( a neurosurgeon at IU) why he should trust him to do the surgery to remove the brain metastases from his testicular cancer.

Dr. Shapiro said, "Because I'm much better at neurosurgery than you are at biking."

I love it. It probably sounds arrogant, but if you met Dr. Shapiro and realized how down to earth he is it is just fantastic proof of his skill. He is humble yet strong.

It reminds me of an experience at Camp Adventure many years ago when Mark Beeson encouraged us to not shrink back and play at the camper's level in sports or whatever we were doing. We weren't to crush them or slam a ball in their face, but playing and living with excellence is inspiring and that is the example they needed to see. The world needs to see that Christ-followers are capable of performing at the highest levels in every arena.

Rite of Passage

My 30 hour shift on call was insane. It was the stuff out of movies, or at least it felt that way. It was one of those days that I knew would happen eventually just not my second time on call. It was me and one other intern taking call on 112 ICU beds and another hundred or so in the progressive care unit. Plus we have to respond to every code blue in the hospital of over 900 beds.

It all started out fine for a few hours while I saw my usual patients. And then one died and I pronounced someone dead for the first time. It was horrible with the family standing around watching me look for signs of life and saying, "Time of death...". How do you tell someone that their loved one is gone? I'm going to be working on that one for a while. I told them that I was sorry for their loss. I filled out the death certificate and all the paperwork and continued to answer my pager (aka "cowbell" as Tara affectionately refers to it) and see new patients in the ICUs.

I had one patient actively having a heart attack and crashing while another new one was needing to be intubated and others were not doing well. So I ran around and took care of things. I was getting pretty backed up but insisted on eating dinner. While I was quickly eating a code blue was called on one of my patients. So I was the white blur sprinting out of the cafeteria nearly vomiting up my tasty dinner. It was clear the patient wouldn't survive, but I was told to try and keep him alive for a couple of hours while lots of relatives rushed in to say goodbye. So it was me, a large and hysterical family, and several nurses and respiratory therapists around the patient's bedside for a couple of hours. The family was very emotional and I tried to work with them to understand what was happening while trying to keep the patient alive. It was exhausting and went on for a couple of hours. During those hours I was getting paged like crazy with new patients to admit, other patients not doing well that I needed to see urgently.... When all the family was there I worked with the family to withdraw all support and I watched the patient slowly die. I watched a wife say goodbye to her husband, children say goodbye to their dad, siblings say their last words. I gave lots of hugs. I pronounced him, filled out the paperwork, and then had to hustle to another patient who wasn't doing well.

I talked with the next patient about his desires if his condition should worsen. It didn't seem necessary to me, but the staff I talked to suggested getting some clarification. It was tough but later proved to be important. If only medical school trained us to talk about difficult subjects with patients and families. Another hysterical family needed to meet with me to discuss their loved ones condition. I met with them and tried to discourage them from making any big decisions in the middle of the night especially since I knew nothing about the patient. I was more of a counselor than anything. I continued to move around for hours seeing critically ill patients. My pager was beeping nonstop with complicated problems.

I put a chest tube in a patient who had a large pneumothorax (air pushing against her lung causing it to collapse). I had been told that it is one of the most rewarding thing that surgeons do and I agree now. She immediately improved significantly. The crazy thing is that a relative of the patient had been at my house the day before. It is a small world.

While I was trying to work on writing notes in the morning the patient I had discussed end-of-life concerns with started coding. I became the white blur sprinting across the hospital again. There were a few doctors there but since I was the primary physician for the patient I was thrust to the head of bed. I intubated him, ran the code, and once again tried to keep him alive while his family came in. I spent hours working with the patient to keep him going, talk with the family about the situation, give hugs, answer questions.... So I kept the patient alive and tried to work with the family to decide when to withdraw support. It was super intense and went on for hours.

I worked with cardiologists, the patients family, and the chaplain to try and decide what was in the patient's best interests. I ended up having to go home before support was withdrawn but I visited them before I left to make sure everyone was on the same page.

So in one 30 hour shift I walked through the imminent death of a loved one with three different families. I had never done that once before. I learned that it is wise to bring a member of security with you to tell a family bad news. I have never pronounced someone dead, talked about withdrawing support with family members, run a code. I met with countless other families to help them understand the prognosis for their loved ones. It was one of those nights that I know makes me a better doctor- both intellectually and compassionately. It won't ever be easy to tell someone that their loved one is not going to survive, but hopefully I can become more eloquent and helpful.

There were many times during the night when I wondered what I had gotten myself into. For 29 of the 30 hours I was moving nonstop seeing patients and putting out fires. It is amazing how mentally alert you can be when you need to! I hope every night on call isn't so eventful, but I feel more confident that I can handle whatever comes my way.

On Call

Please excuse the picture- I was very tired when Tara took this last weekend! Maybe that is how I always look since sleep is becoming a rare commodity.

I just got back from a fun night out on the water by my house with some friends- enjoying good food and great company.

Tomorrow is my second day on call. It will be a long 30 hour shift. I'm doing trauma/critical care medicine (at a level one trauma center) and it is a weekend in the summertime so it will be very busy. I hope I don't see any of you there.

So far I am loving it! My body is certainly adjusting to sleep deprivation but I have never been more certain that I am doing exactly what I am supposed to be doing where I am doing it. God is faithful and good! And now I am off to sleep.

HIPAA

I can't say much thanks to HIPAA, but I'm taking care of a loved one of a familyI love and respect immensely. I never would have imagined that would happen so quickly. It's pretty humbling and a little scary!

Tomorrow is my first night on call. I'm not sure who needs more prayer- me or the patients.

Bring it!

Beginner's Luck???

My first day as a real doctor went so much better than I could have imagined. It was wild to introduce myself as "Dr. Qualey" for the first time. Every time I wrote an order in a chart it felt weird not asking a doctor to cosign the order. Nurses actually sought me out to ask questions and update me on our patients. Families asked to speak with me to talk about their loved one's situation.

Within 60 minutes of being in the ICU I had to go emergently intubate a patient. In addition to never having met the patient I had to quickly talk with the family, get their consent for the procedure (which I've never done), and intubate a patient (which I haven't done in 2 years) who just happened to have a broken neck. It was crazy! As we were trying to get the patient sedated I felt my legs shaking a little as everyone was watching me. The amazing/miraculous thing is that I was able to intubate her on the first try with lots of people in the room staring at me. I have never intubated someone on the first try, let alone someone who is crashing and who has a broken neck. My attending was very pleased!

Then throughout the day I had to put in a few central lines (catheters into large veins). My attending was clearly dreading what he thought would be painfully long procedures, but all 3 times I hit the vein on the first try. It was ridiculous. The first time he told me I seemed like a natural. The second time he told me that it was going to be a great month together because I am obviously a natural with "the touch". I laughed and told him that I hoped he was right, but it was probably just beginner's luck. He said, "No seriously, you have the touch. It's obvious."

Are you kidding me?!? On my first day of residency I expected to be pummeled verbally by surgeons, not have one tell me that I am a natural. I am under no delusion that I will always have this kind of success nor will I get warm fuzzies from my attendings often, but I sure needed it today. I'm still very inexperienced, but at least I know I have hope! Thanks so much for all of your prayers and encouragement! God is so good!

Bring it on!

In case you are curious I am nauseous, terrified and excited about starting residency in the morning. I feel entirely unprepared, which is ok because everyone does. It has been great spending these days with the other surgery interns, realizing that we are all in this together. Here are the things I am most concerned about:

• Responding to every code in the hospital (when a patient is actively dying). I am not ready to run a code. Since I'm in the ICU that should change quickly.
• Breaking bad news. I feel entirely unprepared to tell families that their loved one has died. Once again, since I am in the ICU I will get a little more rapid introduction to this difficult part of medicine. I can only hope and pray that God's love will shine through in those times.
• Being on call. I don't pull all-nighters regularly. I made it through college and the first two years of medical school with at least 4 hours of sleep every night. Even as a medical student when we were on call we typically slept a little. The one time I have truly stayed up all night in the hospital I fell asleep standing up in the OR, I cried like a baby when I misplaced a sheet of paper.... Now I need to stay up for 30+ hours and actually be mentally aware enough to make important medical decisions.
• Being on call and being paged about both medical and surgical ICU patients. I am training to be a surgeon which involves quite a bit of medicine, but the medical ICU patients are a completely different beast. Not more difficult, just different.

I can't wait to see how God more than compensates and redeems my weaknesses and shortcomings. I am beginning a 5+ year journey tomorrow that is what I have dreamed about since I was a little kid. I wish everyone could see the smirk on my face that I will inevitably have tomorrow when I introduce myself as "Dr. Qualey" for the first time.

What I've learned from orientation

Now that orientation is well underway here are a few things I have realized:

• I am in way over my head
• My responsibilities are beyond what I am capable of
• Since I am the intern on the ICU team I am responsible for going to every code in the whole hospital...a hospital that is a maze and currently beyond my understanding (probably because whoever came up with the "floorplan" was drunk and high at the time). I will be the white blur running around at 3 am trying to save someone's life.
• I will spend the next few days understanding the "floorplan" so that I can promptly find the room of anyone in need of my services
• I actually think I could do a surgical airway if needed
• I am incredibly excited to be at IU surrounded by residents that I already know and for the most part enjoy
• The intern class rocks! There are 4 girls (all from IU and super fun and reasonable people) and 5 boys (2 from IU and three from other schools). We are about to share a whole lot of insane memories together.
  
• My baseline blood pressure is elevated due to my nervousness of all that is to come
• God is good. I have never been happier about being at IU. It has been a blast getting to know residents and faculty better.
  
• I will always have backup. While it is terrifying, the patient care will be just as sound as ever as there are tons of doctors, nurses... who understand that July is a volatile time and they are ready and willing to help.
  

Graduation Part Two

As promised I have much more to say about my recent graduation. It was truly the most incredible day of my life. I have wanted to be a doctor since I was in early elementary school. I used to tell my teachers and parents that I was going to be a heart surgeon... when I was seven. 18 years later and I am a week away from being a surgical resident. I'm not sure if I'll become a cardiothoracic surgeon (it's amazing how the medical community has a fancy way of saying just about everything), but it is one of the options I have thrown around quite a bit.

So on May 10th when they introduced me as "Doctor Angela Hope Qualey" for the first time it wasn't simply a catchy title, it was the realization of my dream. I was a little emotional when I was on the stage, but not as much as I anticipated. Despite being on a beta blocker my heart was still racing. Kelley's dad, Dr. Schreiner, the chief of Riley Children's Hospital gave me a hug on the stage and said a few words to me that I won't soon forget. I grabbed my diploma and ran off the stage before they could change their mind. Not really, but I did check to make sure they really put my diploma in the cylinder.

After everyone received their diplomas we recited the Oath of Hippocrates which was very meaningful for me. I took it seriously. I didn't mindlessly regurgitate the words. I am honored to be the keeper of secrets for my patients. I know things about patients that they've never told anyone. I am honored to treat all patients equally.

The most emotional part of the ceremony was the very end when they had us stand and they introduced us as the class of 2008 and the crowd went wild cheering for us. I ended up sitting right across the aisle from my family and friends and so I was able to look them in the eye as they cheered me and my classmates on and it was incredible. I felt God's pleasure and love in a palpable way through them. God is good!

After a lengthy photo shoot we went for a nice lunch at The Capital Grille in the Conrad Hotel downtown. I took the opportunity to introduce everyone, say a few words to each person, and pray for our meal. It meant a lot to me to take that time and attempt to honor each person there who has had a significant role in my life and in helping me successfully graduate from medical school. My parents, Rigel, uncle Brad, Dr. Schreiner and Kelley all gave wonderful toasts. My cousin Brad sang a beautiful song. It was a really special time with family and friends.

After that we had a casual evening of Scat (a card game my family plays often-they even have a website for it), pizza and presents.

I am so thankful for my friends and family who traveled from all over the country to be together and celebrate. I couldn't have done this by myself. The journey has just begun and I am surrounded by the best support system imaginable!

The Long White Coat

I just got my long white coats with Angela Qualey, M.D. embroidered on them and it fills me with fear and incredible joy. For those of you who don't spend your lives roaming around academic medical centers, the long white coats are for doctors while medical students wear the shorter, far less flattering and uncomfortable ones. Seriously, I hated my short white coat. It looked even worse on men, but I avoided wearing it whenever possible. It didn't help that they gave us one that was to last us for two years. I am cheap and refused to pay to have it cleaned and I am also lazy and so I rarely cleaned it. It became a petri dish that I am sure would provide instant immunity from everything to any newborn who was wrapped in it. I pondered saving it for such an occasion, but decided against it. Now I have four coats that will be dry-cleaned whenever I want on the surgery program's tab and I will get several more coats every year.

Life is good. Well it is for another week until I introduce myself to my first patient as "Dr. Qualey" and write an order in a chart that doesn't need to be cosigned before it is put into action.


One of the best things said at graduation was that "society expects a transformation to have taken place". Somehow on May 10th when they gave me my degree and called me "Dr. Angela Hope Qualey" a magical shift took place and I became competent, professional, and everything else you expect of a doctor. I assure you that there is a ton that I don't know and I'm still working on the professionalism (I did have a patient tell me I was treating him like the Jews treated Jesus). These next few months will be some of the hardest in my life (or at least that's what everyone has told me), but I will learn more in them than ever before. In the meantime I've got a few more days of vacation before orientation begins. Let the good times roll!

Texas

I just got back from a wonderful week in Texas. I had a few days with Rigel. He took me to a ranch on the Llano River where we kayaked, learned how to fly fish/got yelled at by the instructor for my poor form (I caught 3 fish thank you very much), talked a lot and shared some high quality time together. He also made a very impressive dinner on the grill. We went out to dinner with a couple that he is good friends with and attended his midweek church service where John Osteen (Joel's brother who is a surgeon) spoke. It was great!
Then I spent a few days with Heather. We went to Schlitterbahn, a waterpark to try and enjoy the Houston inferno. The Tidal Wave River was fantastic! We spent lots of time talking, eating, and laughing. Sorry we didn't take a single picture.
Thanks for a great week Rigel and Heather!