Almost too much

I don't really know what to say about the last nine months.  They have been the most difficult, challenging, demeaning, awful months of my life.    As it turns out, being a female surgical resident in a program with a more than healthy dose of the old boy's club is painful.  Incredibly painful. Knives in your gut kind of painful.

I have been told I'm too feminine to be a surgeon.  I've been told no male will take me seriously because I dress well. I've been instructed to wear my hair pulled back in a conservative knot since the long curls are "too much".  I've been coerced into trading in all of my heels for flats.  My wardrobe has been forcefully changed to khaki slacks and button down shirts.  I have been taunted, teased, and tortured by various male attendings who find my lack of a Y chromosome to be quite infuriating.

I have bent a knee.  I have genuflected.  I have conceded many a battle to continue my surgical training.  I have sacrificed. By the grace of God, I have not yet been broken. However, it's been touch and go more than once.

I'm tired.

I would appreciate any support in prayer any one is willing to give.

Don't Snort and Drive

I'm knee deep in my trauma rotation at the moment.  In the past two weeks, I have learned something very important about myself.

I am not a trauma surgeon.

I do not like bullet wounds.  I do not like stab wounds.  I do not like patients who get high and run their cars into trees/ culverts/ other cars/ log trucks/ pedestrians.  (In fact, I am now afraid to drive at all in this town because if my last Thursday is any indication, over half of all drivers are on their way to methadone clinic, high and on their way to methadone clinic, or just high.)

This explains why on my one of four days off this month, I have barricaded myself in my home with my dog, a six pack of Coke, and all of the seasons of How I Met Your Mother.  It's a safe place.

A slice of hope

I went for pizza yesterday.  Cheese pizza, obviously, as the enforced vegetarianism is going strong.

My waiter, a lovely guy, stopped to ask how things were going.

"Great, thanks!"

Waiter, "Would you like some esperanza sauce for your pizza?"

"I beg your pardon?"

"Esperanza.  It's our special sauce.  Do you want esperanza on your pizza?"

I grinned.  "No thank you.  I like my pizza hopeless."

He blinked at me.  Blink.  Blink.  "Huh?"

I didn't feel like explaining it, so I brushed it off.  I promptly texted my best friend to share my joke.


Always practical, she wrote back.  "How does hope taste?"

"Like Caesar salad dressing."

"Hmmm.  I'm not a fan of hope then."


I love her.


(Esperanza means hope in Spanish, for those who might not know.)

Bubbly

We were having a discussion about a patient who was so pathologically happy and cheerful that it was easy to imagine she would be quite at home in a cheerleading uniform or as a TV anchor.  We had no idea why she was so cheery, but it bothered us.  It annoyed us.  It irked us.  This speaks much more of the psyche of a resident than it does of the patient.  She was lovely.

My attending paused, thoughtful.  "Maybe it's because she's Southern.  Southern girls are bubbly."

My chief, a beautiful but serious girl stared him down.  "I'm Southern.  I'm not bubbly."

He had no rebuttal.

Orphanage

We were fortunate to be allowed to visit one of the many orphanages during our time in Haiti. 

Zanmi Beni is not your usual orphanage.  It is a permanent home for physically and mentally disabled children established after the earthquake. Zanmi Beni means 'blessed friend' in Haitian Creole. The children now living at the home were living in the pediatric ward of Port-au-Prince's General Hospital prior to the earthquake. In a country where resources are scarce, having a disabled child is an arduous undertaking.  Many of the children were abandoned or left by their families at the hospital.  The hospital was damaged badly during the earthquake, leaving them essentially homeless.

The orphanage is working toward becoming completely self sustainable, an admirable goal in any country, but an especially impressive one in Haiti.  They have a mango and banana grove, garden full of little seedlings, feisty chickens, lazy turkeys, and a tilapia farm.  They are even recycling the waste from the tilapia to make fertilizer for their gardens. 

                

                   

The care givers at Zanmi Beni have some of the most giving hearts that I have experienced - something that is essential to their mission.  Unlike many orphanages, the children at Zanmi Beni are not up for adoption. They have found a permanent home.  There they will have the chance to complete school, a rare occurrence anywhere in Haiti.  I was told that a child is more likely to be forced into servitude than he or she is to finish sixth grade; only 18 percent of children are enrolled in secondary school.   The children at Zanmi Beni will also be taught a trade or skill to help to rescue them from the almost certain poverty and social ostracism that they would have faced otherwise.

 

They are currently in the process of building new dormitories for both the staff and the children.  Currently most of the staff live in tents or buildings on the property.   All of the children sleep in one building, metal cribs lined up in rows. 

I know that these children are in a very good place. They have opportunities here that they would not have otherwise be afforded.  Logically I know that.

Still, it breaks my heart.

We brought them crayons and notepads as gifts.  There was one little guy, Marcus, who completely stole my heart.  I tucked a crayon behind his ear, and he was dumbfounded.  He spent the next ten minutes handing me crayons and turning his head so I could put them behind his ear.  We could only get two at a time to stay without falling.  

The most heart wrenching aspect of the orphanage  for me was the nature of some of the disabilities.  Some children had severe disabilities like muscular dystrophy.  However several babies had a very curable disability like club feet.  It was challenging to see children who had been abandoned by their families and written off by society because of a condition that is easily treated in the United States.  I was reminded again how blessed I am.

Thank you

A patient that our group had previously flown back to the United Stated for further work-up was on our flight to Haiti.  We had hoped to offer more aggressive treatment, but unfortunately once he arrived his disease was found to be too far progressed and deemed terminal.  He was flying home to be with his family when he died. It was a sobering start to the trip.

We reminded each other that resources were not going to be anything like what we were used to having.  

We had no idea how different it was actually going to be.

We were met by our hosts and our patient's family when we arrived in Port Au Prince .  The family  had brought us a bag full of fresh mangoes  to say thank you for the care we had provided for their loved one.  In a country where many of the inhabitants aren't sure when their next meal will be, they were offering us fruit from their trees.   One family member said to us, 'You tried.  Now we know that all has been done. It is in God's hands and is His will.' They thanked us even though they knew we couldn't do anything more. 

That accepting, loving spirit was displayed to me over and over during my time there.  The thankfulness and joy that the people found in the face of conditions that would be unacceptable in a developed country was humbling.

Haiti

I know I promised to blog about my trip to Haiti, but it has taken me awhile to be able to talk about the trip with my usual irreverence. The trip was life changing for me - which sounds cliche when I type it.  This may be a prosthelytizing series of posts, but the experience has changed my opinions on many things.

My flight to Miami was delayed, but uneventful. The flight from Miami to Port Au Prince was packed with volunteers for various groups.  People going to build houses, to teach vacation bible school, to work on clean drinking water, to build a church.  Southern Baptist men groups, Episcopalians, non-profits - they were all represented.  White haired church ladies and ten year old boys with their earbuds perpetually crammed in their ears were all headed down to help in some fashion. Everyone was aflutter about all the good they were going to do.

Me?  I was scared.

I knew I was the only general surgeon on this trip - an intimidating thought.






 

Give me a squeeze...

I'm on colorectal surgery at the moment.  This means poo - lots and lots of poo.

I really don't like poo.

In fact, it makes me want to flap my hands around in horror like a girly girl scared of a spider or other creepy crawling beast. However, girly girl is not appropriate in the operating room.

Rectal exams are a big part of colorectal, shockingly enough. You have to check both the resting tone and the squeeze tone.  (I also dislike this.)

My attending was doing a rectal exam a while back and he had checked resting tone.  Next he asked the patient to squeeze his finger.

We have very compliant patients - the patient reached behind him, grabbed my attending's hand, and squeezed as hard as he could.

The Bed

My friend Cory's family has an amazing log cabin in the North that makes my heart melt a little bit.  It's rugged, beautiful, challenging to get to, and pretty much everything a girl could ever want in a Northern woods cabin.  It's on a darling little island and to get there you have to canoe or ski depending on the season.  It's like heaven on earth.  

It also has a enormous screened porch that wraps around two sides of the cabin giving you a wonderful view of the lake sunsets and sunrises.  On one side of the porch is one of the dining tables.  On the other side is a bed.  It's not just any bed.  It's a hanging bed.  

I heart this bed. 

This green bed is not Cory's bed; it's from Lowe's.  Cory's bed is much more minimalist with white bedding, thick chains, and no seashell headboard.  The first time I saw The Bed I was very skeptical.  Who sleeps on a swinging bed?  Don't you get motion sick?  What if you fell out?

Then I slept in The Bed. 

Now one of my goals in life is to have a house that has a porch with my own version of The Bed.  Why settle for beds with legs that touch the ground? 

 

Elections

I just received the email that our team mission is a "go".  We were informed last month that we might be canceled depending on the election results and resulting response in Haiti.  The election results were supposed to be announced tomorrow.  They have now been postponed until Monday after we arrive.

They also told us that the security threat was level 4.

That's very helpful, but they failed to tell us how many levels there are.  Is level 4 somewhere around "don't walk around wearing big diamonds as you might get robbed" or more like "the plagues of locusts and frogs have nothing on the stuff you are about to see"?

Slight difference.

Either way, I am DEET and permethrin prepared.  It won't do much for the locusts or frogs, but at least the mosquitoes might leave me alone.  I would like to avoid malaria if at all possible.  I have accepted I will probably catch something.  I just would like it to be a manageable infectious disease.

* Image is courtesy of WHO Malaria Department.  It can also be found here.  I do not own this image nor claim to have any rights to this image.*

Fleeing the country

I'm fleeing the country on Saturday.  Okay, so not technically fleeing, but leaving for a wee bit.

I've been blessed to be allowed to go to Haiti with a group providing sustainable medical care for those in the Port-au-Prince area.  I was able to use some of my vacation time to go and was given the full support of my department attendings.  I can not tell you all how wonderful it feels to finally be able to give more back after all the years I've been in school.  This is something that I'm passionate about and feel so very blessed to have the opportunity to do.

I am super excited.

I am super nervous.

I had to see the international travel clinic doctor to prepare for the trip.  I am quite aware that doctors in general make awful patients.  I am no exception.  I knew that I would have to get shots for this trip.  You guys, I hate needles.  Rumor has it that I once passed out getting my tuberculosis skin test.  This has never been confirmed as the only eye-witnesses mysteriously disappeared.  Despite this abhorrence of needles, I am now vaccinated against hepatitis and typhoid, have started my prophylaxis for malaria, and have prescriptions to treat cholera. (Haiti is a dangerous place, infectious disease-wise.)

I also went in to take my mandatory annual tuberculosis skin test.  Turns out that the typhoid vaccine is a live virus, and you can't take a TB skin test if you are taking a live virus.  Golly gee whiz, did that upset me.  Terrible news.  Guess the evil employee health nurse will have to wait 'til another day to torture me with her needles.  I really couldn't have planned this better.



** Image from wwwp.greenwichmeantime.com   I did not draw or create this map, and thank the owners very much for letting me borrow it.**

Sacrifices

Residency, you win.

DH and I are heading our separate ways.  He's a wonderful man, and we both care about each other a lot.  So while we still like each other and have not resorted to quarreling over spatulas, we're parting amicably.

He's going to go on to do wonderful things - probably get his PhD, teach, move to Alaska, grow a beard.  Well, maybe not a full beard.  He does have some areas that refuse to grow facial hair.  Maybe grow a partial beard.  He's a fantastic man, and I wish him all the best.

Me?

I'm going to continue residency.  As he is fond of telling me, I married my job, and I make a terrible bigamist.

So it looks like it's just you and me, Residency.  Take your shoes off at the door.  I just scrubbed the floors and don't want you tracking blood everywhere. 

Niagara Falls

Just like I have multiple tricks to help a patient poo, I have multiple tricks to help a patient pee.  Non-urinating also will buy you another day on my list and a catheter.  I've yet to meet the man who wants to have a tube shoved up his urethra, so tricks to pee are popular.

I was rounding with one of my attending's over the New Year holiday, and we had a patient who was failing his void trial (chance to urinate before the catheter and he became friends).  I had tried all my tricks and was out of advice.

My attending walked in the room, looked at the patient and said," Well, you aren't trying to pee lying there are you?  Stand up, my man.  Niagara Falls doesn't flow uphill."  

It worked.

Photo from Niagara Region.Com  

Poo

Doctors in general are overly interested in poo. Color, frequency, consistency.  You name it, and we probably want to know about it.  This is not really advertised when you start medical school.

Every morning when I round on my patients, I listen to their heart and lungs, push on their bellies, check their wounds or drain or both, and fire off this list of questions in rapid succession:

"Are you eating? Have you passed gas yet? Are you nauseous?  Did you vomit?"

"Have you had a bowel movement?  What was it like?  Would you like something to help you have a bowel movement?"

Occasionally a patient can't poo after surgery for one reason or another.  This is bad juju.  No poo means that the patient will be staying in the hospital another day.  Which means they will be on my list another day.  Which means I have to round on them another day.  Which means I get ten less minutes to eat/sleep/play with my pup/study/sleep.  Which makes me grumpy.

All of that leads me to this morning when I gave an 87 year old gentleman a high five for having a bowel movement.

I'm not terribly proud of that moment, but I have ten more minutes to sleep tomorrow.

Wonderful and terrible

The thing about residency is that sometimes it's wonderful, and sometimes it's awful, and sometimes it's both at the same time.  Like today.

Today I made a bunch of split second decisions that saved a man's life.  The orders poured out of my mouth, and the nurse was right there, and she was fantastic, and he's alive. He's going to hug his grandkids again and kiss his wife and maybe make it out of this hospital.

Today no matter what I did, no matter how many drugs and tricks and interventions I threw at one patient, he passed away.

I'm not sure what emotions I'm supposed to have after a day like this.  So I just go home, take a long, hot shower, and tell myself that tomorrow will be a wonderful day. After all, it's really not anything that I did or didn't do.  I believe that God was ready for one man to come home and still had plans on earth for the other.  I have to believe that.

Post call

So it's September second, and I'm sitting on my couch post call, and I cannot think straight.

I know I have a long road ahead of me.  Most days I can face that pretty well because I love what I do.  Every day that I get to go in and operate is a good day.  Today, post call, is less of a good day.

Post call has its own set of rules that I will go over some time.  Suffice to say for now, that it is not the healthiest of times.  The only place I want to be is laying in my hammock sleeping the afternoon away.  Instead I have to study for chief conference and prepare for my O.R. cases tomorrow.

I need a shower.  I need to buy groceries.  I need to remember where I put my pager because the damn thing is going off again even though I left the hospital an hour and a half ago, and it's haunting me like a parole ankle bracelet that lets everyone know where I am at all times.

And I cannot think straight.

Breakfast

I know that breakfast is the most important meal of the day.

I think sleep is more important.

This is why my daily breakfast consists of whatever I put my hands upon at four in the morning.

Eggo's take too long.

Ice cream is too difficult to eat while driving.

Which is why my breakfast the past month has consisted of Gatorade, fudgesicles, and cheese grits.  This is not a diet I would recommend.  It does let me sleep me an extra five minutes, and those five minutes are essential to my well being.  They totally make up for my elevated cholesterol.

*Photo from A Taste of Home.  I'm sure they have it copyrighted.  It is not mine.  

Pre-op

I was presenting a patient to an attending a couple of days ago, and he interrupted me mid chief complaint.

"Q, what is this guy pre-op for?"

"Dr. M, he's not a surgical patient yet.  We're trying conservative medical management."

He looked at me sternly.

"We're born pre-op.  We just don't know what we're pre-op for until later."

God, I love surgeons.

Sleeves?

Today I was evaluating a patient who was post-op from a mastectomy with axillary lymph node dissection.  One of the complications we look for in these patients is lymphedema - swelling of the hand and arm from lymph back up after surgery.  This particular patient was having some occasional trouble with lymphedema when she traveled.

When I presented the patient to my attending, she asked if the patient was wearing a sleeve.

I looked at her, puzzled.

"No.  She wasn't wearing sleeves.  She was wearing a really cute sleeveless Lilly Pulitzer dress."

She looked at me, then started giggling.

"A sleeve - a medical sleeve to prevent swelling."

At least I know clothes....

Fashion or function?

I just switched from the hardest service at my program to the happiest service.  It was like the gates of heaven opened for me when I walked into the hospital on Monday.  One of my co-interns took over the service from Hades. 

One of my previous attendings looked her up and down on her first day on service in clinic. He noted her adorable driving loafers.

Then he said," I see that you and Q are polar opposites in the footwear department."

What can I say guys? 

I will pick fashion over function almost every time.

*Shoes are Christian Louboutin and completely drool worthy.