Black Clouds

There is a joke around the hospital that I am a black cloud. Basically I have been on call a ton in the past few weeks (6 nights in 2 weeks) and every one of those nights has been full of disasters. The chief residents (who take call from home) have picked up on it and seem less excited to have me on call with them as they will inevitably have to come in and take a patient to the OR with me.

Let me preserve my dignity by saying I didn't in any way cause these problems but they all arose while I was the only "surgeon" in the hospital (someday I will be able to call myself a surgeon without using quotes). Several of the patients were transferred in from smaller hospitals in the middle of the night and were incredibly sick. Another several presented to our emergency department and a few were already in the hospital being treated by other services.

The common thread is that they all (yes, every last one) required emergency surgery. That is exceedingly uncommon. We usually get consults for all sorts of non-operative issues, and a few that need surgery. Last night was my last night on call for a while. A patient we have been taking care of for a long time started hemorrhaging rapidly from somewhere in the intestines. I was transfusing the patient as fast as the blood bank could send blood up and he managed to pull through the night. I explained to the family how grim the prognosis is in an effort to get them to reassess how far they want us to go in what seems like futile care. In the end, the decision is theirs, but I feel a moral obligation to be clear about how serious a situation is so they can make educated decisions.

The good news is that most of the patients have done very well and I have gained all sorts of experience in resuscitating patients, counseling families and quickly delegating and getting things done. I seem to have earned the respect of the staff surgeons which is always a good thing. The bad news is that I am exhausted. I have been basically pulling an all-nighter every other night for 2 weeks without a single day off in several weeks.

The even better news is that this will quickly be remedied as I fly to Puerto Vallarta in the morning for a week of bliss. My pager is being left behind, my phone is off, I won't be checking email. I will be all there...resting...having fun.... Adios!

Slumdog Millionaire

I saw this movie tonight with a couple of friends and was completely blown away! It resonated deeply with my burden for the millions in India and around the world who are victims of horrific crimes. I understand why this movie won Best Picture. I pray that this platform not only helps spread the word for the horrors happening still today around the world but invokes real change.

FYI- if you are interested in learning more check out: International Justice Mission. This is an organization strategically speaking up and defending the rights of those whose voice is not heard. Another organization getting things done is Emmanuel Hospital Association in India- the organization I worked alongside for a summer at Landour Community Hospital.

How To Save a Life

I had the incredible privilege this week of being involved in saving a life. I'm sure that happens regularly, but it is usually not as obvious. It is likely the most significant moment of my intern year so far. Here's the short version...

At 5pm our team was paged to come see a patient of ours who had had surgery several days prior. Acutely his blood pressure was very low and he felt light headed (there's more to it but I'm trying to keep this brief). I quickly transferred him to the ICU and as soon as we rolled into the ICU he started seizing and became unresponsive and his abdomen instantly became distended. We quickly noticed (he was in the process of being hooked up to their monitors) that he had stopped breathing. I was unable to feel any pulses so we quickly started CPR. I taught the medical students to do compressions as someone ran to get blood, paged anesthesia to intubate the patient, started giving code drugs, paged staff to come to the hospital stat... I quickly ran to the OR and told them that we needed an OR now as a patient was hemorrhaging and would be dead within minutes. They told me that there was no room available, no staff, no anesthesia and therefore we would be unable to bring our patient back. At that moment I made it clear that this wasn't optional and we didn't need anything but instruments. Since the charge nurse was less than helpful I ran from OR to OR calling for any available help and managed to round up 3 anesthesiologists, a scrub nurse, and several other OR nursing staff. We grabbed an available surgeon who was in the hospital and wheeled our patient to the OR within minutes. The staff surgeon (who drove in at 110mph on the highway) ran in as we were ready to open the abdomen. As soon as we did we were met by 5+ liters of blood (an average adult has approximately 6 liters of blood). Staff told us we had one chance to get to the bleeding artery (a branch directly off the aorta) before he exsanguinated entirely. We succeeded and quickly controlled the bleeding as the anesthesiologists frantically kept resuscitating the patient. When we were done the room looked like a slaughter house. It was amazing!

The next day when I walked into the ICU I saw a man breathing on his own, talking and asking for more pain medicine. It was the most incredible realization that this relatively young man is alive without any real residual damage (other than a large scar on his abdomen) when he was within minutes of losing his life. I had fun walking around to the nurses on the floor that had picked up quickly on his unstable condition to tell them that their quick thinking was essential to his good outcome.

I spoke with the patient and without getting too graphic explained how miraculous it is that he is alive.

I am so thankful to have been an integral part in resuscitating this man!

Momentum

I don't have many blogs on my Google reader, but one person I follow regularly is Mark Batterson. He is the lead pastor at National Community Church in Washington DC. He recently said,

I've always been convicted and challenged by something R.T. Kendall wrote in his book, Yesterday's Man: "A person with a tremendous anointing yesterday can continue to see the momentum of that anointing continuing to manifest itself. He or she may hastily conclude that 'the anointing is still with us' when it is but the momentum of yesterday's anointing. If I do not experience a fresh anointing every day, it is only a matter of time before I become yesterday's man.

This has been bouncing around in my head since I read it. Am I just living off of the momentum of my past or am I truly growing and allowing God to change and refine me?

25 Things

There's this thing going around facebook where you list 25 apparently random or little-known facts about yourself. Since I actually have a free evening I thought I would give it a shot.

1. My Myers Briggs test flipped and apparently I'm an extrovert now. I used to be solely energized by alone time and now (maybe out of necessity) I am very energized by time with others. It's kind of fun being more extroverted. I do enjoy my alone time though!
2. I played a blue guitar for a semester in college. I loved it but I think all the girls in my dorm secretly loathed the guitar...maybe because I could only play one song but I loved it so I played it over and over and over and over and over and over and over.
3. I've been craving the Grasshopper shake at Ivanhoes for 9 months now. Sure I could make my own but it's just not the same. This weekend my college roommate Heather is coming to town and our whole clan from Taylor are reuniting for a day of fun including Ivanhoes.
   
4. I took voice lessons in college. I somehow got roped into a solo performance of some Enya song. I have blocked out the details, but it was amazing...amazingly horrific and appauling but oh so funny. I still sing along to Enya for a few privileged individuals.
   
5. I gave up Mountain Dew. It was a decision based on the high fructose corn syrup and desire to be a little healthier. Diet Coke is the new Mtn Dew.
6. I give the best musical performances while driving and trying to stay awake. I use props, interpretive dance, the steering wheel drum, and sign language (don't worry it's not all at the same time). I get some confused looks, but I'll never see those people again...right?
   
7. The Fray is one of my favorite bands and their new cd came out today. My copy is in the mail. I saw them perform a couple of years ago in the craziest outdoor concert. They had to turn all the stage lights off because the bugs were so bad they couldn't sing. Isaac Slade called it "Armageddon"
8. I am obsessed with exercise. The rougher the day at the hospital the harder I exercise. Not a wonder I'm in good shape right now.
   
9. I am a recovering people-pleaser. This year has cured me of any desire or effort to please others as I realized it is physically impossible to do so in a surgical residency.
   
10. I've got some freakish heart issue. I'm seeing a new cardiac electrophysiologist next week so we'll see what happens. It's thrown a wrench in obtaining disability insurance.
    
11. I like to read 5-8 books at a time.
12. I am so excited to travel around the world training surgeons in developing countries whatever specialty I decide to go into.
    
13. My neighbor does all my yard work, snow shoveling, house maintenance. He's amazing and I'm humbled by his generosity.
14. I am addicted to cornbread pancakes now that I know how to make them.
    
15. My two fitness goals for this year are to compete in another triathlon and to swim in the Big Shoulders open water swim on the lakeshore in Chicago.
    
16. I am actively serving in a very amazing local church. I am all in and so excited for our future together.
    
17. I probably have 6-9 years of training remaining. The future is still very undecided but transplant surgery is at the top of the list for now. I guess I like flying around in private jets.
    
18. I can't wait to go snowboarding again.
    
19. I dream of going to Antarctica someday as the physician at their station. Another option is the international space station (which my mom's cousin heads up) but I think the isolation would be difficult as a newly proclaimed extrovert.
20. I am insanely competitive at sports. It's not because I care about winning as much as I love playing hard and having a good game. 99% of the time I truly don't care about the outcome.
21. I am a diehard Colts fan. I dream of getting a blue foam colt head and cheering like crazy in Lucas Oil Stadium in an upcoming season.
22. I long for the day when I can go back to India. It's been over 5 years and I miss it.
23. I am a sock snob. If they don't have built in arch supports and just the right fit I won't buy them. I'm on my feet too much to go cheap on socks.
24. I have a recently revealed talent on the drums in Rock Band. I'm thinking of trying some real drums soon.
    
25. I miss my family and friends who aren't in Indy a lot. I am blessed beyond comprehension!

Snowboard 1 Angie 0

Yesterday I went skiing/snowboarding with Brad, a good friend from my house church. I apologize for not having any pictures. The majority of skiing was nighttime so they wouldn't have turned out well had I had a camera with me. Your imagination will have to suffice.

The skiing was great. As Brad said, "it is like riding a bike" and I was quickly able to maneuver around thanks to lots of previous experience. My one fall was hysterical. I saw a ramp, gained speed and was surprised by how airborne I became. I landed fairly gracefully on both feet but was laughing so hard at my stunt that I totally lost it. When Brad came around the corner I was lying on the grounding laughing and rolling around. It was pretty funny.

After much prodding on my part we traded the skis for snowboards. I had brought wristguards for just this occasion knowing that just about everyone I know who has tried snowboarding has broken a wrist and my livelihood now depends on the functionality of my upper extremities. We carried our boards to the bunny hill- hill might actually be too generous, it was more of a flat clearing to learn to turn on. There was a treadmill to take you to the "top". Brad had warned me that I would feel fairly physically handicapped with one leg stuck to the board. He wasn't kidding. I felt like I had some congenital hip dysplasia that prevented any forward progress. When we got to the "top" I locked my other foot in and lasted about 10 feet before being forcefully thrown on my face. The wristguards worked though! Getting up was a serious struggle and one that I was determined to win as other newbies were barreling forward in my direction. I couldn't stop laughing as I was so shocked at the violent nature of this sport. This continued for an hour of so with unending laughter and rolling around in the snow. I told Brad that "our" goal would be to ride the ski lift and go down a real hill before the night was over. We indeed did accomplish the goal and miraculously didn't have to cart either of us down on a sled. There was a close call when Brad flipped end-over-end after losing control. We must have been a sight to behold!
Today I am quite sore. My knees are bruised but my spirit isn't. I can't wait to go back for round two!