satisfacer

i feel so satisfied lately.

i work long hours, but i'm like a sponge and i soak everything up that i don't know.

and even though i started on a rotation that is incredibly difficult, my having to keep myself afloat has made my initiation into doctorhood that much more expedient. i feel like a doctor. i feel like a surgeon, and that makes the days not seem so laborious.

and i love where i live.

i surf everyday.

yesterday i was out with my best friend an hour or so before sunset. we watched dolphins swim by and each caught a couple really beautiful waves. the water was warm and the sun seemed to take up half the horizon as it set. it was beautiful. and then i walked home...to my beautiful apartment. and i thought about how lucky i am. this is my best case scenario, it really is, and i am so thankful for it.

photos

the unit is still full of incredibly sick people, and there still hasn't been a day someone hasn't gotten shot. in fact, two nights ago (when i was on call) a 4 year old girl was shot in the belly. she is doing fine, but only after a major operation. a spent the whole day wondering how someone could do such a thing.

the other patient that has been consuming my thoughts is the young woman who was shot on the fourth of july. she continues to suffer, and is on something called ECMO now, which stands for extracorpeal membrane oxygenation. it is basically a lung bypass machine. after being shot and having surgery, she went into severe ARDS, which stands for acute respiratory distress syndrome. this is where the lungs basically become damaged, go into shock and are unable to oxygenate or ventillate the body. this condition has a very very high mortality rate. in trauma patients, especially young ones, there is hope that if you place them on ECMO, you can rest the lungs, give them time to heal, and the problem will reverse. being on ECMO, however, means that there is little else that can be done, and the patient is in serious danger of succumbing to their injuries. there are numerous complications to using ECMO, including bleeding to death because being put of the machine requires thining the blood out be able to run it through the "prosthetic lung".

so this young girl is on ECMO, and she has been getting blood transfusions at a rate of more than 12 units/day. her face and body are so swollen that you can barely make out her eyes, her lips, her nose, the creases in her palms or fingers. she is so sick. i have often wondered what she really looks like

yesterday when i came in to the unit her friends and family had hung up pictures of her all around her bed...on the cardiac monitor, above the headboard, on the lung bypass machine and on an IV pole. there were pictures everywhere, of a beautiful young woman, surrounded by her friends, smiling, glowing. i looked up at the pictures and down at her poor struggling body and a sadness just filled every part of me.

what an amazing family she has. even in putting up those pictures they force everyone to recognize that all the effort we are putting in is valid. that we really are working to save a life, not just an empty body lying on a bed.

a young woman 17 years old survived ECMO in our unit a few months ago...so there is hope that it can work again. but everyone says this woman is much more sick than the last. it will be a miracle if she survives.

the violence that effects this country, especially in the inner city, especially directed against blacks and other minorities, has never been this real. tupac and biggie and 50 cent and whoever else that raps about thug life weren't just making that stuff up. everytime i hear some of that on the radio on my way home from work, i can connect to it in a whole new way. i see the destruction that poverty and violence and guns cause. i see it and i am being trained to deal with it in a very practical way. guns are one of the worse tools we, as human beings, ever created.

stray bullets

the fourth of july is about patriotism, parades, fireworks, cookouts, and, as i found out last night, stray bullets.

i think last night was my 4th call, and each time i have stayed overnight a young black man or woman has gotten shot. last night it was an 17 year old woman. the surgical intensive care is basically the admitting unit for really sick trauma surgery patients. i, the SICU intern, am in charge of the unit patients.

usually, the trauma surgery team on call with me doesn't really give me warning about who is going to get admitted, usually because they come from the OR via the ER. the nurses in the unit always know that someone is on their way to the unit before I do. i thought it was just their innate wisdom, but after asking one of them, they told me they can always tell because the family collects outside the door.

at around 3am I left the unit to look at an xray downstairs and there were 20+ people in the hallway, family members of a young girl who had been shot through her chest. i walked past them all, their eyes all on me and wondered what kind of shape their loved one would be in.

in my first week of residency i have been the person that most family members talk to to find out how their loved one is doing. mostly because i'm the only spanish speaker, and i'm the only one who basically lives in the unit.

last night, i had a crowd of people around me as i explained that the young girl had been shot through her armpit, and that the bullet went through both lungs, pancreas, spleen, colon, and diaphragm.

most people looked into my eyes dazed, tearful, hanging on every word that i said. one of the more bold family members asked questions.

"what is the spleen?"
"can she live without it?"
"will she be able to walk again?"

and then she looked over at the father and asked the question everyone wanted to know.

"is she going to make it?"

i told her there was no way to know how she would do, but that she was stable.

"but doctor, have you ever seen someone like this, with gunshot wounds like this, make it through alive?"

i told her i had, but that no two patients are the same.

"all i wanted was a little bit of hope," she said.

i guess a little bit of hope has to be a good thing.
as i finished rounding and writing notes on all of the patients in the unit, i watch the crowd of people around the young girl's bed.

there were 4 girls her age, standing around her battered, bloody body. they talked to her, found a way to laugh, to try to make her less scared. although she was sedated and unable to respond, i know their dialogue with her was welcome.

i thought about how brave these young girls were, to stay by their friends side, while she was hooked up to monitors from every corner, dried blood on her face, eyes curled back under the influence of a sedative and a tube down her throat. she must have been hard to recognize.

i watch as they held it together in front of her, and broke down the minute their backs were to the bed.

i had few comforting words for them, but they were so appreciative of me. i felt it was undeserved, and instead thought about how them being there made the place seem more humane.

i look forward to the day where a young black man or woman escapes the trauma bay, and i can say that bullets aren't part of what this country is about.