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This week's Sunday Six is brought to you by Going Home for the Holidays. Here are the first six things I have done in the 48 hours since I arrived in Colorado:

1. I finished two books and started two more.

This is the kind of book that you don't ever want to end.  I started it months ago and this trip makes the third vacation I have now taken and read it on, and I was sad as soon as I finished it.  Just an incredibly well-written, epic story with awesome characters and a fantastic premise.

This was a Christmas gift last year and I finally got around to starting it this past summer.  For weeks I would get through maybe two pages every night before passing out... I got about halfway through it this way, and then surgery started nine weeks ago and I hadn't picked it up since.  I read the other half on the plane ride here.  It's all about the little things we can do to improve the safety record in surgery and medicine in general - sounds like a total yawn, right?  Gawande makes it completely fascinating and inspiring, especially having just been on that rotation.

I saw Santaland Diaries a few weeks ago in Atlanta - a hilarious play based on the first chapter of the inimitable David Sedaris' book filled with hysterically funny observations about holidays with family.  The play was awesome and inspired me to get the book and read the rest of it.  Sedaris fans, people who like humor and anyone who has ever experienced a Christmas that was anything other than post-card perfect will love this one.

This one's a re-read for me.  You all obviously know by now my giant crush on admiration for Atul Gawande.  This is his first book and I read it back when I was applying to post-bacc programs, when my dream of going to medical school and becoming a doctor was still just in its infancy.  Just as good - now with some medical experience, if not better, the second time around.

2. Lots of good food: I ate a Chipotle burrito bowl literally as soon as I exited the Denver airport, courtesy of my brother Matthew (I know this is not a uniquely Colorado thing anymore [thank God!] but it does have a strong family association :)).  Banana pecan waffles with Nutella for breakfast, home-cooked dinner, Grandparents joining us for dessert, multiple ice cream flavor choices to go with Dad's birthday angel-food cake, Mom's latte, hand-delivered to me in bed (seriously, folks, this is the life!!), Sunday brunch... awesome deliciousness.

3. I have slept more hours than I did on my entire last week of surgery combined. 

4. Took Izzy to explore the local dog parks and on some long, chilly walks.

5. Yoga!  My friend Lindsay has opened a beautiful, amazing studio here in Ft. Collins.  If you are a Northern Colorado yogi, go check it out!!  Your body will thank you.

6. Enjoyed some hardcore snuggling with the two other snuggliest family members.  :)  (Haha... Ellen is going to kill me for putting these on here, but they are too funny not to...)

Sunday Six

Here's a Sunday Six list for you: the six people I love most in the world, and am undyingly, heart-burstingly grateful to have in my life, and alive and well on this chilly, gloomy Sunday.  

That's all I've got today.  So thankful for my family.

Happy Anniversary!

One year ago today, this happened.

I tell people that she was like my unplanned pregnancy.  I definitely did not think that one through, and if I had, I would have logically and very sensibly concluded that second year of medical school - in the midst of boards studying, no less - was not exactly the ideal time to get myself a puppy, to say the least. 

But she came, and I kept her, and I still could not be happier or more grateful that Izzy became mine.  :) 

Trauma

I don't care what surgery service you're on, even if it's not trauma - it's ALL trauma.

Seriously?  Surgery is trauma for everyone involved.  Even an uncomplicated, routine case involves fairly significant trauma for the patient.  Don't be fooled into thinking otherwise - it is very carefully controlled trauma, but trauma nonetheless.  Minimally invasive?  I mean, sure, you end up with three or four tiny little neatly-closed incisions around the belly, but have you ever seen the whole process?  The way those trocars get maneuvered around in their ports, the shoving things around, tearing things down, cauterizing whole swaths of tissue... man.  I love watching surgeries.  I think it's the coolest thing, and it is super easy to become desensitized to the violence of it.  But yikes.  Surgery is no joke. 

It is also trauma for the residents and the med students.  At least for me it is... the whole time you're standing there during the surgery, the attending can pimp you at will - basically, he or she can just ask you anything they want to ask, related to the surgery or not - and I never feel totally confident about my answers.  It can happen at any time and without warning... you're never free to just relax, you always have to be on guard for random flying tricky questions smacking you in the face and making you look like a total idiot.  It can be trauma for the nursing staff and the scrub techs - some attendings have notorious temper control issues, and all attendings have very different, nuanced personal preferences about how they like things set up, what they like to use, etc, and they are not shy about letting someone know when they don't get it right.

Surgery is trauma physically and emotionally, too.  Being on your feet all day is less than ideal for your back.  The crazy hours lend themselves to terrible self-care.  I have literally not worked out in three weeks now and am starting to feel totally nuts mentally and super crappy physically.  Nutrition has mostly gone to pot - remember the cookie party on Sunday night?  Yeah, it has basically sustained me all week.  Only I have long-since finished the actual cookies and have now started in on the huge batch of gingerbread cookiedough that never made it to the baking stage on Sunday.  That was my dinner tonight.  Not kidding.  Trauma regarding my personal life - today, my attending asked me if I had kids.  When the answer was no, the question was, well, are you married?  No?  Ok, well, what about someone special, then?  I said no, absolutely nothing, nothing at all going on my life.  And his response was wellllll.... at least... at least you can do what you want whenever you want...?

It's even trauma for the floor nurses. Ok, so this incident didn't actually have anything to do with surgery, and I don't even know if it was one of our patients that was involved, but when I got to work a couple of mornings ago, some of the nurses were shaking their heads and muttering in disgust.  When I asked, one nurse told me that everyone was all in a tizzy because one of the patient's parents had been, shall we say, getting amorous in the patient's hospital room.  Not only that, but it was happening while the patient, a young baby, was crying the entire time.  And not only that, but the nurses knew this because they could hear it from out in the hall!  Ugh, really?  Gross.

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And then there is the actual trauma.  The awful, horrible, heart-pounding, life-flight bloody trauma, that, when you are in a pediatric hospital, can just be too much to bear.  

Last night there was one of those.  

It came in just as I was about to leave at a decent time in the afternoon, and it was absolutely horrific.  There are really no words for when something like that happens to a small child.  But one of the worst,  sickest aspects of the whole experience?  The truth is that a part of me was thrilled to be there for this case.  It feels horrible to admit that.  It was such a hideous tragedy.  I think I was mostly just so happy to finally be helping, to finally be useful, to finally be able to use skills that I actually do have and to feel like I actually did know what to do and how to do it and then actually be able to do it.  I love being in the operating room when I am getting to participate. 

We operated for probably close to seven hours, sewing and sewing, trying to put this little girl back together.  

When we finished around midnight, I went home and slept for roughly about three hours before I got up to go back in this morning.  We rounded, went to grand rounds, had lecture, went to clinic, went back to the school for a lab on advanced vascular access.  

It was sort of a shitty, blah daze of a day.  A reminder that I have not even started to do a fraction of the studying I need to do for the exam that is fast approaching.  No breakfast food left, no coffee made, not even any crappy energy bars left to grab on my way out the door.  A text from my landlord letting me know that hey, fyi, your rent check bounced, again.  Oh yeah, my financial situation is still so far down the shitter that it is actually in the water-treatment facility an hour down the highway.  Half a dozen more automated phone calls from my credit card company telling me that my payment is late, again.  Which was then followed by a voicemail informing me that my precious doggie has finally figured out that she can clear the fence and so now, even though we have finally bullet-proofed the gate that she had continuously, ingeniously found a way to foil until very recently, she is still escaping.  And when she was put back in the yard and tethered to a line set up on her leash, she chewed straight through her leash and severed it completely.  Her dog walker has apparently not been showing up and she has also somehow destroyed the latch on her crate door, so now I have zero good options for her while I am gone for 14-hour days.  

I wore heels today.  My feet were killing me.  When I left the school, it was dark already.  I walked to the parking garage in the dark, drove home in the dark, got home to a completely dark house.  Not a single car in the driveway, not a single person at home.  And I just burst into tears and proceeded to have a small breakdown.  My first cry on surgery.  My first cry in a good long while, actually.  My roommates got home a little while later and walked in and said "hi" to me and I started crying again.  I took a long, hot shower and sobbed.  I am crying right now, sitting in bed and typing.  

I don't really know how to deal with this stuff.  When I started this post a couple of days ago, I meant for it to be sort of a funny "wow, this is super tiring and intense and ridiculous and how about those inappropriate parents?!" post, but then last night happened, and I was mostly really put-together about it until a couple of hours ago.  Now I just feel drained and exhausted beyond belief and I can't think about last night at all without crying.

If you are a pray-er, maybe say some extra-special ones for a little girl in an intensive care unit tonight.  She has a really hard road ahead. 

Surgery Dreams

... dreams that I have while on my surgery rotation, that is.  Let me know if you want to take a stab at deconstructing this one.

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Last night, I dreamt that I was in some sort of indoor/outdoor castle for some sort of interview (unclear what the interview as for - it seemed to be some sort of admissions or job interview, or possibly both - you know how things can do that in dreams) and I was interviewing with a close friend, and the interviewer was a surgeon (again, not entirely clear why, maybe the school/job had to do with surgery, I don't know, but he was a very important and intimidating person.)  And I thought it was all going quite well, until at one point, for some reason, I had to stand up to deliver my responses for that part of the interview, and for some reason, there was what I thought was a hand-sanitizer dispenser on the wall next to me, and for some reason I knew that I had to clean my hands before I would be allowed to speak, and so I  stood up, reached out my hand, dispensed some into my open palm and then proceeded to rub my hands together, immediately realizing that I had made a mistake, and that it was actually regular soap instead of sanitizer, and so now I was in the middle of this very important interview, wearing a suit, with both hands entirely covered in liquid soap.  No sooner had I made this tragic error than the surgeon-interviewer lowered his chin, scowling at me from under furrowed brow, folded his hands on his lap and announced that my interview was over.  And my very good friend, who had been seated behind me while all of this happened, laughed at me and said something to the effect of "too bad for you" before continuing to converse with the interviewer, with whom she suddenly was best friends. 

It was awful.  

And then after that my flying skills came in handy when I joined some sort of outdoor field game involving something like keep-away with a small French horn.  Whatever.

On second thought, if you know anything about dream interpretation, I probably don't want to hear your read on this.

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PS.  Last night, we hosted a Christmas-cookie-baking party at our house... sooooo you can guess what my dinner was when I arrived home twenty minutes ago.  Also, I am seriously contemplating sleeping in clean scrubs so that I can save the 38 seconds that it takes to put them on in the morning.  Don't judge.  I am also going to bed NOW... it's 8:30 pm and I have to get up in less than 8 hours already. Sweet sleepy Jesus.