Luminous Heart

late last night i administered anesthesia to a young girl whose unintended pregnancy entered the final throes of demise.  she was 16 weeks pregnant and 3 minutes after starting the procedure the ob-gyn had scooped out the fetus and it fell with a thud into an awaiting bucket.  16 weeks, the fetus was smothered in blood; it already had hands with little fingers, feet, and a face.  the original intent of the procedure was to terminate the pregnancy because the baby was already trying to come out, too early... "but the baby is already dead.  she has already miscarried," the ob-gyn declared.  the image of the fetus disturbed me for hours, but the entire thing didn't feel quite real; the girl hadn't wanted her pregnancy and didn't even ask about the baby after the procedure was done. 

life in general hasn't seemed quite real.  i don't know what time it is or what day it is.
wednesday:  worked straight from 6:10 am until 5:00 am thursday morning.  staggered into bed in the call room; woke up at 7:30 am to leave the hospital and go home.  went home, stayed up 'til 10 am, then staggered into my own bed and slept til 5:00 pm.  got up, showered, B came home, and we drove around running errands.  went to bed at 9:30 pm.
friday:  woke up at 4:40 am, started work at 6:10 am, worked straight until 10 pm, slept fitfully through the night in the call room; luckily no cases or code blues or other errands to be done, woke up at 7:00 am saturday and came home.
couldn't sleep when i got home.  went out for lunch with B and overfilled myself with venezuelan arepas in west roxbury.  drove to somerville to do our shopping in the whole haunts.  fell asleep on the car ride home.  now relaxing at home with B, dreading the return to work tomorrow, sunday, at which point another 24 hours of work begins.

i used to pride myself on never getting sick despite being surrounded by sick patients every day; people i lived with and worked with got sick every year without fail and i managed to stay healthy...  until this week.

the last time i got sick was in spring of 2000-- eight years ago!  the fever broke and my bedsheets drenched in sweat at a bed & breakfast on the island of nantucket.  stepping off the boat in the dark of night and walking through the mist-- was it real or part of the delirium?  B still remembers it so it must be real.

this time around it hasn't been quite so romantic; fever and bedsheets drenched in sweat in my own bed in my own home.  the fever broke relatively quickly but then this awful cough came, wracking my body day and night, taking away my voice and my ability to talk.  i missed several days of work and even the annual in-service examination yesterday, quite a big deal.  i finally saw my doctor and was started on azithromycin for atypical pneumonia.  i can't wait to get better and be able to do the things i normally am able to do; i'm tired of being sick!

as mentioned in a previous post, i don't think i've ever pulled a true all-nighter.  i'd always managed to find time to squeeze a nap here and there throughout all those nights being on-call as a medicine intern and then as a first year anesthesia resident.  my first on-call as a second year anesthesia resident though, this july 4th weekend, i got clobbered.  first there was a rash of violence throughout the city which made top headlines and ultimately trickled down to us.  i came in on saturday morning at 7 and literally worked in the operating room for 24 hours straight until 7 the next morning.  i had approximately 1 hour total time out of the OR sprinkled throughout the day, during which i scarved down food, water, and bathroom time.  the cases just kept coming and coming in waves.  just as you thought it couldn't get any worse, it got worse.  to those who are outside of the medical profession, being on call means working during off-hours (night or weekend).  the number of staff available is markedly limited; for example, there are only 2 of us residents and 1 supervising attending.  ideally there would only be 1 operating room going at a time during the weekend, which allows the 2 of us residents to take turns doing cases and rest every other case.  not so on saturday when we were running at full capacity, 2 rooms the entire 24 hours, leaving neither of us a chance for breaks or naps at all.  my breaking point occured at 4 am, with 3 hours left to go... i found myself nodding off for seconds at a time while my patient (a head-on car accident victim, no seatbelt) lay sleeping under general anesthesia under my care.  i alone in the world was responsible for keeping this guy alive while the surgeons fixed his wounds and i was falling asleep.  they tell us again and again to call someone when this happens, so that someone can relieve us for a brief while until we regain our wakefulness again, but this time there was nobody to call.  we were stretched thin.  i forced myself to walk around the room and stay awake... and eventually 7 am came around and my reliefs (the residents on call sunday) came in so i could go home.

during grand rounds this morning (our usual monday morning conference) we met all the new residents.  there are so many girls in the new class, unlike my class where there are only 2 including me.  they were true girly girls, in high heels, shiny tops, skirts or tight pants, hair done in curls, makeup on their faces... and looks of bright-eyed innocence.  they went around the room introducing themselves with a short three line biography... and nearly everyone of them added at the end, "and i'm so excited to be here."  ('what is this, a beauty pageant?' B says when i tell him about it tonight.)  my classmates and the residents in the senior class above me looked at each other and smiled sardonically.  these new people didn't look as haggard and as battle weary as we did.  "they look so happy!" i say to one of my colleagues.  "they don't know what it's going to be really like," he says.

i said and felt these things because i am a bitter and wretched resident.  i love what i do but it gets beaten out of me by the long hours and interminable demands.  i was probably jealous of their freshness and naivete, of their ability to look great and feel free... while i have dark circles under my eyes, can't remember the last time i bought something new and feminine to wear, and feel imprisoned by time.

i looked around at my fellow colleagues and felt that we had gone through something extraordinary together in the past year, akin to war.  we'd been in the trenches together and suffered together.  these new people were like outsiders in comparison.  they hadn't yet gone through what we'd gone through and i couldn't feel empathy for them just yet.

not the most pleasant of thoughts but they are my honest ones. 

i started this vox blog almost exactly a year ago as i started my anesthesia residency and it chronicles my growth.  i can't believe i was just in their shoes one year ago.  how much life has changed.

today is the last day of june, which means the last day of the academic year (in the medical world).  tomorrow will officially be my first day as a third year resident, which means only two more years to go.  the fresh wave of anesthesia residents will be coming in tomorrow, but they won't be taking overnight calls for 6 full weeks so we'll be working doubly hard to cover those overnight shifts that are no longer being covered by the senior class that has graduated and left us-- shifts which obviously can't be covered by the incoming class either until mid-august.  i'm more excited about the pay raise that comes with each new academic year.  there's also a lot of exciting, challenging rotations that i'll have to do this year (cardiac anesthesia, thoracic anesthesia, vascular, obstetric, etc) but i'm more nervous than excited about that right now.

some of the minor stresses i alluded to in the previous post includes this.  over the last few years i've been living in apartments that are part of a complex and are managed by big management companies that typically have their brand of apartments all over the U.S.  i preferred this over the the type of apartments i used to live in, which would be in a multi-family house or one brick building, for example, and managed by one specific landlord.  the management companies offered more, or so it seemed.  ie, gyms, swimming pools, parking spaces, and everytime you moved into a new apt it would be freshly painted, redone, etc.  but not without a price.

i moved out of my last apartment earlier this month and recently got a hefty bill in the mail, to the tune of almost $800.  there was a complete checklist of things we apparently did not do, like vacuum the bedroom, dining room, and living room.  i couldn't believe this, i pored over every inch of carpet in that apt vacuuming each room; i'm pretty sure the vacuum left its typical marks on the carpet (you know what i'm talking about).  i was so vigorous in my cleaning that the vacuum cleaner broke before i could finish the last half of the last room... so i'll admit that part wasn't vacuumed; but the rest... please.  there was also 'trash' that i didn't remove, according to their checklist, which as i now recall were things i accidentally left behind.  a few things only, like 2 tennis rackets, a container of pet supplies, and hairspray.  they could've called us to pick it up instead of charging $180?  unfortunately i didn't think to take  my own pictures (since i didn't think this would ever happen), whereas their letter claimed to have pictures on file as evidence.  from talking with co-workers who have lived with big management companies before, this appears to be regular practice... even after meticulous cleaning on their part they were hit with charges too.

i was just going to stew over it for a while and then eventually bite the gun and pay the bill... but b, ever the lawyer, put his foot down.  he wants to take this to small claims court.  "what's there to lose?"  he asked me.  "the worst thing that could happen is we'd lost $40 in court fees and have to pay the bill.  but we have a lot to gain if we win."  so today we went to the district court in the area where we used to live, and we filled out our affidavit.  now we just sit and wait; the court will send a certified letter to the management company notifying them that they have been sued, and we'll wait for them to either settle with us or go to court against us (probably counter-suing us in the process).  i'm not hopeful, but B is right; what have we got to lose?  

one of the cardiothoracic surgeons was overhead saying that he has only slept three hours a night every night for a great many years.  not only has he survived, but he has thrived (professionally).  i personally am skeptical; either he's lying or he must be compensating for it with naps.  i do acknowledge that there is great variability in people's needs for sleep.  i am one of those who seem to require 9 to 10 hours of sleep in order to feel refreshed, but in my line of work this is basically an unrequited dream.  not only that, but there seems to be this moral uppity-ness amongst medical professionals, equating lack of sleep with god-like valor.  i still remember how my roommate in first year medical school was telling our other friend that i "liked to sleep" (and she said this with such moral vindication).  she herself pulled all-nighters frequently, staying at the library all night and not coming back to our dorm room until the following morning-- staggering, rubbing her eyes because her contact lenses were dried out and stuck to her eyeballs, etc.  i never could figure out why she thought she was superior because i slept for 8 hours and she slept for 15 minutes, but the truth of the matter was i graduated in the top 5% of our class without ever having pulled an all-nighter (during our non-hospital years) and she struggled night after night just to get acceptable grades at best.  even now i have never literally stayed up working for 24 hours; i always steal away to take a quick nap when possible.  i need my sleep.

lately i've been more sleep deprived than usual (ie, sleep deprived for me means getting 6 hours of sleep or less).  reasons include my new commute, which is longer (takes me an hour to get home in the evenings), staffing issues at the hospital which leaves us shorthanded and staying until really late each day, and other minor and not so minor stresses in my life.  my schedule is also such that i'm in the midst of working three weeks straight without a real day off.  my mood and attitude have clearly changed for the worst.  i'm filled with so much pent-up frustration and anger, 95% of which i take out on B.  i have been so irritated and frustrated with him all week, which is unusual since we'd been going through a good spell.

so i'm off to bed now to try & get 8 hours of sleep; it's 8:37 pm now and i have to get up at 4:40 am.  'night!

after spending the month of may in the surgical icu, it was great to return to the operating room this week and do anesthesia again with a new pair of eyes.  didn't realize i would feel this way, but i am so glad to be back, doing what i love!  i was non-stop busy and exhausted though, with no time to pack.  i came home friday morning after being at the hospital for 24 hours, but did i start to pack?  no, slept for two hours, ran errands, and didn't resume packing until evening.  it was a marathon session until saturday afternoon when the movers came.  but now i'm here, in the new place with B and our two dogs and one cat, and it's lovely.  when we walk the dogs it feels like we're on vacation somewhere at a resort.  not sure why it feels that way.  maybe it's the way the buildings are constructed, or maybe because half the buildings are still being constructed and there aren't a lot people/cars/noise yet, or maybe because it's so warm outside and summer is finally here.  new beginnings, chapters closed.  the town still has so much to be discovered; whenever someone who's from massachusetts asks where i'm moving to and i name this town, they say oh, that's a nice town, a lovely town.  not sure how everyone knows it's such a nice place to live when there really is no reason for people (who don't live here) to ever come here or drive through here (it's that quiet), but somehow it has this reputation.  the old apartment is not officially a chapter closed; we had to return today to clean, move some leftovers out, and we still have not yet returned the keys (lease isn't officially up until the 13th.)  i'll be glad when it's finally done.  right now, still living out of boxes and spending way too much money on eating out 3 times a day.  tomorrow i'll start my new commute, which i have heard horror stories about, and will be on call so i won't come back until tuesday.  'til then!

somewhere in the wilderness of maine, a man named william poor was born and his family became one of the most prosperous names in town.  someday he would become the originating point of Standard and Poor's-- proof that even the most illustrious of men can come from humble origins.  andover, maine is still a humble town; population 864; a half mile stretches between each house.  abandoned shacks from another century line some roads, horses and cows graze on vast plains of grass, and daisy fields warm the eyes with their brilliant contrasts of yellow and green.  and all around the horizon stands a pristine visage of snow-peaked mountains and tall pines reaching for the stars.  i recall the first time B brought me here 8 years ago; he was worried about how i would react.  at the time his mother (who had returned here to live after her children grew up) and his grandparents lived in a very humble home, where eight children (B's mother and her siblings) were raised and their father went to work at a paper mill.  then the father  (b's grandfather) died, but the mother and grandmother and one uncle continued to stay, until unfortunate circumstances caused the home to be lost.  now the mother and grandmother live in a mobile home not far from where they used to live.  maybe B was worried because he thought i'd be uncomfortable, as this was different from where i come from.  but mansions in an expensive neighborhood are also empty and lonely, as is the childhood i grew up in where everyone stayed in their own bedrooms, manners were cold and proper, and the big house cold and sterile as a museum.  everytime i have come to visit B's family in maine, they have sat around the dinner table talking, laughing, playing cards.  sitting on the porch watching the occasional car drive by and letting the dogs lap happily through the grass.  the 18 year old car rusty, but still running, parked on the dirt driveway.  the neighbors' hens strutting from their chicken coops to taunt my chihuahua and drive her mad.  looking at old black and white pictures of people who once lived, and loved.  no sounds of suburban traffic here, just bugs and breezy mountain air.

the sudbury inn, where we slept, was also a nice surprise and worth it if you're ever in bethel, maine during ski season, or even if you happen to be there during off-season like we were. 

i am sad to be back in suburban boston and returning to the hospital tomorrow morning.

Got two hours of sleep on call last night; came home this morning and slept til 5 pm and still feel like crap.  B had a better day; he got a surprise call from the highest boss and is being transferred in two weeks to headquarters and getting an early raise in salary.  Headquarters will be 50 miles away from our new place though.  An old college friend came to town for a conference and I was supposed to meet him this evening.  I felt like a zombie when I woke up at 5 pm though, and as I talked to him over the phone it irked me how stuffy he now sounds.  He's doing residency at a fancy Ivy League university, has gotten a prestigious fellowship at the same place for next year, and just doesn't sound as fun as he used to.  I hadn't seen him in a few years and wanted to meet, but after our phone call, just didn't feel it anymore. 

B wants to visit his mother in rural Maine this weekend.  The town is rural enough that there isn't even a bed and breakfast there.  I booked a room in the nearest touristy town-- 20 miles away.  Having scored five star luxury hotels on priceline.com for $50 a night in the past, it seems absurd to be paying over a hundred dollars a night in rural Maine, for a room that reminds me of an old woman's spare bedroom in the attic.  But I'm jumping at the chance to escape the city and the ICU for a weekend in the country with B and the dogs (and the future in-laws).  Running away is what I like best.

we're moving in three weeks so i've sort of stopped caring about the place where we currently live.  what i used to love about this apartment complex was that, despite being so close to the highway and the malls and the restaurants, it was hidden, tucked away.  you couldn't see it from the main road and to get here you have to drive up a circuitous road amidst granite formations and trees. 

unfortunately, the 'wheels of progress' have encroached into our little space.  a big tall office building, devoid of personality or character, is being built alongside our circuitous road.  it was and is a private road, hardly traveled by cars, but now there will be many new office workers traveling up and down this driveway every day.  the office building has made its presence known, as our horizon is now completely blocked by it.  however, i didn't really attach any disappointment to this business since i knew we'd be moving away.

while we were walking the dogs the other night, b wondered out loud why they were plowing away all the wild grass and flowers near our parking lot.  it's far enough away from the new office building that we couldn't figure out what it was for.  perhaps it's a new parking lot for them, he said.  what used to be a vista of tall green grass and wildflowers was now completely gone, replaced by piles of sand here and there, pushed up by bulldozers.  "you know what makes me most sad?" he said.  "i can't bear to think of all the wildlife that used to live there.  where will they go now?"

i hadn't thought about it myself and when he said that it made me want to hug him and love him so much.  that's my b, worrying about even the littlest of creatures-- the bunny rabbits we sometimes see in the early morning hours, the birds that B gives our old bread to, and the squirrel we saw running for his life from the construction crew.  and ever since then, when i see the devastated landscape i think of him and how he's right and how our urbanization has come at such a price.

i like to remember him by the things he says like this.  it helps me to forget the other things that he's capable of saying to other women which break my heart.