restart

yesterday was my last day in the medical ICU and of course i was on call. i got an admission to rule them all - with everything wrong that could possibly go wrong. it's been a long, grueling month and i've been desperate for a minute to breathe. this month - more than any prior - i've been leaning on my fellow interns. spending 80+ hours a week desperately trying to bring lives back from the downward death spiral of the ICU... grappling with the suddenness of it all with families... finding no time to process what became known only as "the shit show"... despite our meager efforts in the precious few moments to ourselves to pull it together, we all reached our respective breaking points. even so, the shared experience of it all brought us together like nothing else i've experienced before.

last night, after i left the hospital at 10pm, i met up with our whole group of residents/interns and spent 4 glorious hours drinking, laughing, and dancing. i was the last one leaving the unit of our team - and when i arrived, i entered to cheers, hugs, and a drink put in my hand. it was the best time i've had in awhile. i was undoubtedly exhilarated to be finished with my ICU duties, but i found myself truly ecstatic to be alive... something i haven't felt much in the past 6 months. what a reflection of my raw human existence and needs that have gone unidentified - needs that were finally met 100-fold last night.

1st day on new service with massive hangover? worth every minute.

i am done with my graceless heart
so tonight i'm gonna cut it out and then restart
and it's hard to dance with a devil on your back
so shake him off, shake it out

.florence and the machine.

fall

took a therapeutic bike ride today through central park. hey new york: you are ridiculously beautiful in the fall. i would have moved here just for this.







and it talks to me in tiptoes
and sings to me inside
it cries out in the darkest night
and breaks in morning light

but with all my education
i can't seem to commend it
and the words are all escaping
and coming back all damaged
and i would put them back in poetry
if i only knew how

all this and heaven too .florence and the machine.

24

one day soon i'm going to post about something other than my all-consuming job. unfortunately it's just that - nearly all-consuming. and it riddles me with doubt and frustration. there are days i want to quit so badly it hurts. today wasn't one of those days. yesterday was, though.

i'm on night float again - did a week of oncology nights, now i'm on 'variety' which means i'm somewhere different each night. oncology was miserable. cancer can be so terrible. i had to pronounce two people - both of whom i had never met, but still cried with their families. last night i was back in the CCU where i recently rotated, and it was actually sort of fun to have continuity and to have a marginal idea about what i was doing.

i was just riding the train home thinking about how bipolar it feels like my life is right now. a good day/night can make all the difference, where a bad day/night makes me certain i will quit. even so, i keep trucking. it's amazing the endurance, patience, and sheer will-power that is being shaped in me. i don't claim any of it - clearly these are not qualities i've figured out how to acquire on my own.

i hadn't heard this switchfoot song in awhile, but it came up on shuffle just before i hopped off the subway. it's such a powerful song and perfectly expresses the things i can't put into words after a long night at the hospital. i fail - yes - and then try again. every day i find myself as someone different from the day before; everyday life has a new dimension. and all i can sing, over and over, is that i'm not copping out. i'm not. i'm staying the course. sing it for me, switchfoot:

twenty four oceans, twenty four skies
twenty four failures and twenty four tries
twenty four finds me in twenty-fourth place
twenty four drop outs at the end of the day

life is not what i thought it was twenty four hours ago
still i'm singing spirit take me up in arms with you
and i'm not who i thought i was twenty four hours ago
still i'm singing spirit take me up in arms with you

i want to see miracles, see the world change
wrestled the angel, for more than a name
for more than a feeling, for more than a cause
i'm singing spirit take me up in arms with you

and you're raising the dead in me
twenty four voices with twenty four hearts
with all of my symphonies in twenty four parts.
i'm not copping out. not copping out. not copping out.

.switchfoot.

head full of doubt / avett brothers

In the fine print they tell me what’s wrong and what’s right
And it comes in black and it comes in white
And I’m frightened by those that don’t see it

When nothing is owed or deserved or expected
And your life doesn’t change by the man that’s elected
If you’re loved by someone, you’re never rejected
Decide what to be and go be it

There was a dream and one day I could see it
Like a bird in a cage I broke in and demanded that somebody free it
And there was a kid with a head full of doubt
So I’ll scream til I die and the last of those bad thoughts are finally out

hold me now

it's time for an update.

to start: intern year has been an explosion of difficulty. although i've probably had moments here and there for an update prior to today, my mind has been swirling with struggle and i've found it hard to articulate what i'm going through. today, as i transition to another week of nights, i took my bike out for a long, sweet 14mi ride. it's amazing what biking is doing for my soul.

here's an excerpt from my journal from several weeks ago:

so it just hit me... intern year is terrifying. it's like this: the first time i went ice-skating as an adult, i just knew i was going to break my neck. i put one foot on the ice, then two... i could do this, right? i gingerly put one foot in front of the other... and my legs slid completely out from under me. i teetered forward, pulled myself back, and just narrowly escaped a head-first dive onto the ice. clearly, i did not know how to do this yet. i whined and cried: "henry, i can't!" i pulled my shaky legs back together and grabbed the wall. i felt like everyone must be pointing, laughing... what is this girl doing out here? she's terrible! she doesn't even know what she's going! i stayed at the wall and watched people glide by so smoothly, so elegantly... they even looked like they were having fun as i stood there scared senseless. would i ever be able to do that? how am i supposed to learn when there are so many people around me who seem to have forgotten what it was like to take those first wobbly steps out onto the ice? will the pace of the swirling bodies ever slow enough for me, timid newbie, to slide into the mix unscathed?

i can think of a million analogies for the way intern year feels. the one i feel most often is that of treading water in a choppy sea... pumping as hard as i can and still being washed over the head with waves, gasping for breath. i'm afloat, but just barely. with my arms flailing and my legs pumping i realize: i have the lives of so many in my hands. i write medication orders, do physical exams, order tests... all while drowning. and, in the midst of it all, the fear that i'll mess up paralyzes me and i sink further under the waves. the cure? experience, knowledge, self-confidence. i'm desperate to acquire these in hopes that i will not only take better care of my patients, but that i'll also be less miserable.

as melodramatic as that all sounds, it's true. i was comparing notes with a fellow intern the other night and we surprised each other when we both admitted we were hoping to find a career path after residency that didn't involve patient care. although it's unlikely that we'll both follow-through with that plan, we agreed that the overwhelming feelings of incompetence attached to autonomous patient care at this moment make us want to flee from it altogether. what a crisis to be doing what you have prepared to do your whole life and feel like you suck at it.

i could leave it there, but i won't. there's hope. i mentioned several months ago at the outset that residency is not something i can do alone. i can't and haven't been. the hope i have in Jesus pushes me through another day - he helps me love others despite my self-doubt, gives me patience when my soul is screaming, and comforts me through situations in which i share in the suffering of his children. he reminds me that trials are certain in this world - but that my reaction is critical. what a pampered, sheltered life i've led for residency to rock me to my core like this. even as i suffer, i'm so grateful to have my eyes opened - to become someone more beautiful than who i was.

i am weak
i am poor
i am broken, Lord
but I'm yours
hold me now
hold me now
.jennifer knapp.

putting out fires

i've got one friend
laying across from me
i did not choose him
he did not choose me
we have no chance
of recovering
laying in hospitals
joy and misery
joy and misery
joy and misery

put out the fire boys
don't stop, don't stop
put out the fire on us

.florence + the machine.

(not the sandwich)

i've discovered that there are a number of things that have totally changed my life recently. some for the better, some for the worse. some are directly related to moving to manhattan, others not so much. a post about all of them would be overwhelming and ridiculous, so i'll take it in pieces.

first up: something that frequently smells of urine, crawls with rats, and inspires the use of earplugs, but is incredibly reliable and definitely the "green" option. give up? that's right, i'm talking about the subway, baby.

ah, the subway. something i was incredibly excited about even before we moved to nyc. no car? no problem! i’d been to many cities that have subways (including living in chicago and london), and knew i would love it. and to cut to the punchline: i do! i absolutely love it, although sometimes it annoys me (just like any true relationship, right?) so here’s why:

i adore not having a car. i hate driving -- and not paying for gas/insurance/maintenance is an added bonus. having to carry home all your groceries makes you think twice about what you buy, and also forces you to take frequent small trips (making your food more often fresh!) on the other hand, i realized recently that i actually used my car as a sort of purgatory for questionable belongings – namely my white coat. it worked as a great, accessible storage locker for germy nastiness that didn't belong in the house.

i have regained my voracious appetite for reading. sitting on the train headed for work (~20min) or to run errands has given me lots of undivided attention to devote to one of my favorite (but recently lost) hobbies: pleasure reading! i never made time for it in med school or college. having the time on the train has been life-changing, as my desire to read spills over into my evenings and late nights at home, too.

i sweat off (and replenish) about 10% of my body weight daily. i don't necessarily love this. waiting in the subway station in new york in july is like going to a sauna -- except you’re wearing clothes and weren’t interested in sweating in the first place. henry carries a hand towel with him. i just use the most miserable facial expression i can muster. we've both raided our local duane reade for $1 gatorade. and, honestly, we often don't escape a day without two showers.

my exercise tolerance? well, it exists now! the new york subway in particular is a labyrinth of stairs, corridors, and awkward paths. very few escalators here. just to get to the subway station, i often walk many city blocks. the first week that we lived here, henry and i thought stairs were going to be the death of us. now, we take them two at a time. it’s not always fun, but it’s manageable. and hey - maybe it'll inspire me to truly get in shape! i've already bought a bike.

don’t get me wrong, the subway is not the greatest thing ever invented. i’ve lost count of the rats i’ve spotted on the tracks. people can be jerks about letting you on/off trains and often, even if you make it onto the train, you don’t get a seat. there are mobs of tourists who haven’t a clue where they’re going (and on random occasions, they even ask you to take their picture on the subway. what?!). and then there are those times when you just missed a train or trains are running slow/aren’t running for whatever reason. even so, there are a million more things not mentioned here that i love about it.

it’s far from perfect, but for me, it’s just the right thing. and i love it.

sunrise

2 weeks in. i'm figuring out where the bathrooms are, which nurses to ask for help, how to do things on the computer. i'm learning that the lab will always lose the blood that i personally drew. i'm learning to rely on my fellow interns not only for advice, but emotional support. i'm getting there, but there are still so many unexpected difficulties.

it was about 4:30am and i was sitting with my fellow night interns in our lair - returning pages, pecking out our admission notes - when an arrest announcement came overhead. it all happened so fast... we ran down the hall, up the two flights of stairs, desperately trying to find the room where a patient's heart had stopped. we got there and stopped moving as quickly as we had begun. we felt for pulses, wondering whether we were feeling only our own. we tried to find out information. we did everything we were taught in our respective ACLS classes (advanced cardiac life support).

my resident started a central line as i held the patient's leg still - a job that got my white coat sleeves covered in blood. anesthesiology arrived and intubated the patient. my fellow interns and i switched off doing chest compressions. the residents watched the cardiac rhythm, pushed drugs, and instructed us. i was mostly emotionally numb to the situation as i tried to pump life into this woman's dying body. the sweat dripping down my brow was in stark contrast to her cold, goose-bumped skin. we sent labs, pushed fluids, delivered shocks - we did everything by the book. she was gone. my resident finally called it at 5:30. we put everything down and walked out - defeated.

as i was walking out of the room, covered in sweat and blood, i noticed the sun had begun to rise. i walked to the end of the hall and caught my breath - it was an absolutely breathtaking view southward from the hospital over lower manhattan and the hudson river, bathed in morning sun.

i've discovered in these two short weeks that this job is hard - the hours are long, the free time non-existent, the criticism merciless. but i've also discovered the intimate, unspeakable difficulties of my job: spending the last hour of someone's life with them beating on their chest. i pray that i continue to feel the sorrow i felt that morning throughout my residency and career - not because i desire misery, but rather empathy - always striving to do the best for my patients.

los necesidades

i have been an intern for a little over a week now, and i've already discovered a few things i'm going to need at the hospital to get me through this year:

1. copious amounts of gatorade
2. Spanish
3. forget about/lose my insecurities
4. Jesus

someone wise once told me that in life, it's imperative to do things so big and important that without the help of Christ i will fail. this person must have had incredible foresight - they were basically describing residency as i've come to understand it.

to be perfectly honesty, it's been brutal so far. not only am i working 13hr days/6 days a week, they are actually overnight. 9pm to 10am. i come in and get handed a list of 40 patients who may or may not be trying to die, and my job is to keep them alive with only a cursory knowledge of what's going on. additionally i admit a patient from the ER who i workup/draw labs/decide on a plan for their care. it is mostly grueling and tedious, although there have been a few moments of joy when i feel like i'm truly helping someone or the team in the morning approves of my decisions. mostly, it's been very isolating and validating to all my insecurities. i'm learning a new hospital system - one where things don't get done when ordered, patient rooms are blocks away, and everyone is busy. it's intern year, right? it's supposed to be like this. i'm excited/apprehensive to see how my feelings will change throughout the year. i'm not going to make it alone. i'm lucky to have henry at my side through it all. i'm ultimately and eternally lucky to have Christ.

i was reminded this morning that one of my coping mechanisms has always been escape through music. an album i'm always going back to: 100 portraits and waterdeep's "enter the worship circle." the songs are based on scripture, mostly hymns. they are incredible feats of percussion - with words of gold. on the subway on the way home this morning, i closed my eyes and felt my spirit lifted with the reminder that the psalmist has been there too - and been rescued.

save me, oh God, for the waters have come up to my neck
i am sinking to the bottom where i cannot stand
i am calling to You, can you hear my cry?

oh my God, You've turned your eyes
And now my heart has come alive

only You have come to find me
only You have come to pull me out
only You have come to save me
only You have come to wrap your arms around me

dr. sharon

proper post will be forthcoming!

since last i jotted my stream of consciousness on this blog, i have done the following things:
1. spent a week and a half in europe (london and paris)
2. graduated from medical school (finally got that MD, baby!)
3. moved to new york (!!!)

just a couple small things. no big deal.

but for now... dr sharona, OUT!

west coast

so the weekend before last, i dragged henry along with me to san diego, ca for the annual american college of physicians conference (ACP). i was presenting a poster - and getting reimbursed by my department - so we decided to make a vacation out of it. a much, much needed vacation.

long story short: the weather was (mostly) perfect, went to (part of) a baseball game, there were baby seals, my conference duties were minimal, our hotel was cushy, saw one of my favorite bands (the dodos) in concert, finally ate at in-n-out, and had awesome seafood. only 48 hours in a city? long enough for the tsays!

check out my picasa album for all the pictures. or look below for a few favorites!

my favorite photographer at the padres-dodgers game. (taken with my phone)

la jolla cove, aka paradise.

seals (and their babies!) at la jolla cove.

another breath-taking view towards torrey pines state park from la jolla.

the grand-finale of awesomeness: standing at the front of the stage at the dodos concert.

fix you

(this post is pretty long, but kind of a glimpse into/treatment for my own suffering. pardon the catharsis.)

the past few weeks have been a blur. two weekends ago, as i blogged about, henry and i took a trip to new york to find an apartment. this past weekend, we headed in a totally opposite (and even farther away) direction - san diego - as i was presenting a poster at the ACP annual conference. fun? more than i can even describe. tiring? immensely.

interspersed between those two weeks, i was on palliative care. talk about a physically, emotionally, and spiritually exhausting experience! my first introduction to palliative care was about a year ago, and it affected me greatly. i wanted to do the rotation this year in order to get better at talking with families/patients and treating symptoms. i absolutely got more than i bargained for - both in invaluable teaching and relentless heart-break.

i rotated on the palliative care "consult team" - which means i responded to requests for assessment from primary patient care teams (like the ICU, oncology, renal) - seeing patients who could potentially benefit from symptomatic treatment, goals of care discussions, or end-of-life arrangements. most of our patients had advanced disease (i.e. a terminal diagnosis).

enter: me. day one. i went to see my first consult, an elderly lady with the worst luck. not only had she suffered from tuberculosis three times in the past, she also had severe emphysema. we were consulted to see her because on top of both of those problems, she had recently been diagnosed with new metastases to her lungs from bladder cancer. she was admitted to the hospital this time gasping for breath with her anxious husband by her side. "how is she doing?" i asked, watching the patient intently, then shifting my gaze to her husband."she's hanging in there," he said. "i just want them to stop hurting her. they keep trying to stick the artery in her wrist to check her 'oxygen numbers.' her wrists are so small and they just dig and dig for that artery. she's crying, can't they see?" this is a fairly common experience in the hospital; a patient has a known, terminal diagnosis, does not wish to undergo extensive treatments, and yet we continue to order painful tests so we can 'check numbers' which ultimately do not change the care we provide for them. they mostly just contribute anxiety and discomfort to the last hours/days/weeks of someone's life. by this point, the husband himself was crying, and i was locating the tissues (something i am now quite astute at). he talked. i listened. we ended up transferring this lady to our palliative care unit where we were able to help get her symptoms under control well enough to go home to her 4month old chihuahua.

this was only my first experience, and honestly, it was one of the more joyous being able to meet physical needs for the patient. i was much less lucky in the following days.

i saw an older lady, diagnosed recently with ALS (a terrible disease where you lose the ability to move, but not your mind/consciousness) who had a rapid decline and was on the ventilator for breathing support. she could only nod yes/no and use her pointer finger to draw letters. her husband was reluctant to talk with her about her condition, as he didn't want to make her more upset. speaking with her one morning, she drew "why did you let them do this to me?" and "take the ventilator off." her husband was devastated. i was too.

i saw a young woman with metastatic pancreatic cancer. it was diagnosed during her pregnancy with her youngest child, all of 6mos old now. she had a total of four young children and was raising them alone. we talked everyday between her episodes of extreme abdominal pain -- and she was terrified. horrified with what was happening to her and paralyzed with fear for what would become of her children. we cried together a lot.

this was the pattern of my days - check the morning list for my patients from the day before to see if anyone had passed, go see my remaining patients, take new consults, choke up, and move on to the next. not much processing time -- and i think this was what allowed me to hold myself together.

even so, there was one particular day that i completely broke down. it was at the end of a very long day; i started seeing mr. g at about 5:30p. he was an older gentleman, not unlike my late grand-pop in appearance and mannerisms. he was a vietnam veteran and sat on his bed fully dressed with his wife by his side. they spoke with thick long island accents and were warm, loving people who clearly supported each other. mr. g had a very aggressive form of cancer that had spread to his bowels and kidneys. he came to the hospital that day because of constipation and urinary symptoms - and it was found that he had a bowel obstruction and his kidneys were failing. without intervention (which he didn't want and wasn't recommended anyways), he had probably a week at most. he was very insightful and talked a lot about his sons who were very successful. he questioned whether he could have done more in life and his wife assured him he had lived well. he sat there in his ski cap, so pale, so straight-faced, and broke my heart. then, from out of no where: "GOD, it's not fair!" --sobbing-- "i just want a little more time with my wife. a few more years to do nice things with her and take care of her." i totally lost it. i sobbed with them. i hugged his wife. when i left the room, i gave him a long, firm, squeezing handshake, the kind you give someone after holding hands in prayer. i was utterly heart-broken for the suffering - for what couldn't be done, what medicine couldn't do, how we had ultimately failed them. i sat at the computer, typing my patient note, weeping shamelessly.

the hardest part of the entire rotation was having an experience like that one and then waking up the next morning and doing it again… meeting another suffering person whose time was short. there were minor joys along the way - being able to help with pain control or help a patient's anxiety - but more soften there was suffering, anger, and my own personal reality of the great limits of modern medicine.

my first week of medical school (four years ago), someone gave a lecture and said - "it's our job as physicians to cheat death - we try to prevent it, lengthen our time before arriving at it, using machines to bring people back from it. but ultimately, we all fail, for everyone will die." it wasn't until recently that i think i understood this. as a direct result, i have tried to change my focus in patient care from "cheating death" to "taking care of people." for if cheating death were really my job, palliative care would not exist. no, my job is to take care of my patients at whatever stage of health or illness and meet their needs (symptomatically)... sometimes giving up hope in modern medicine's ability to cure, but NEVER giving up on my patients.

------

when you try your best, but don't succeed

when you get what you want, but not what you need

when you feel so tired, but you can't sleep

stuck in reverse

and the tears come streaming down your face

when you lose something you can't replace

when you love someone but it goes to waste

could it be worse?

lights will guide you home

and ignite your bones

and i will try to fix you.

.coldplay.

then and now and soon

so henry and i went up to new york last weekend for our epic apartment search. we worked with a broker - who was a friend of a friend - and saw a bunch of apartments. ultimately, we just fell head-over-heels in love with the one we chose. yes, it's incredibly expensive. we prepared for that... it's manhattan, after all... but i'm trying not to think about that. what i am focusing on: we have a home in new york! i'm sure i'll share much more about it once we move.

while we were in new york this time, we strolled around central park. 2 years ago, henry took me to nyc for our 1st wedding anniversary. we had one particularly wonderful afternoon on that trip strolling around central park in which we ended up relaxing on a bench near the lake. because we're silly, sentimental, and obsessed with our new home, we decided to recreate the afternoon! we strolled, relaxed on our bench, and snapped another picture. not much has changed in our physical appearance over these two short years - but if you could photograph the excitement we both share for our future here, it would be overwhelming.

july 2009


april 2011

concrete jungle

so it’s official: i matched at columbia university for internal medicine residency and henry and i will be moving to NYC in just a few short months. ::deep breath:: NYC! the capital of the world!

i never wrote a post about my interviews – opinions, preferences, etc. this was deliberate at the time as i did not want to taint any opportunity at places before i “matched.” now that the match has passed, i will say with great excitement and humility that columbia was my favorite program – and my first choice. there were a number of other programs i really liked (& some that i really didn’t), but in the end it ultimately didn’t even matter which i ranked second. i feel so incredibly lucky.

…and thus begins the next chapter of our lives. i start at columbia on june 9. between now and then, henry and i are undertaking the (insufferable) task of finding a manhattan apartment. we are selling our cars. we are craigslisting/donating/trashing most of the furniture/excess stuff we’ve accumulated. henry is going voluntarily unemployed here in hopes of finding a similar/even more awesome job in NYC. and we’re so excited about all of it. although i never imagined i would live in nyc, this is somehow the day i’ve been waiting to embrace for a long time.

take it away alicia:

in new york, concrete jungle where dreams are made, oh
there’s nothing you can’t do, now you’re in new york
these streets will make you feel brand new
big lights will inspire you, let’s hear it for new york
new york, new york

.jay-z & alicia keys, empire state of mind.

3

in three weeks, i will know where henry and i are moving in 3 months for at least the next 3 years. it's going to be a long 3 weeks.

...good thing henry is making me laugh by catching pictures of what our cats do while i'm sleeping. (i had no idea this happened/picture existed until henry showed it to me tonight. :-P)

same

but the people on the street
out on buses or on feet
we all got the same blood flow...

sometimes we forget who we got
who they are
oh, who they are not
there is so much more in love
than black and white
keep it loose child
gotta keep it tight
keep it loose child
keep it tight

.amos lee.

interviews

26 flights. 12 interview days. 7 taxis. 5 hotel rooms. 4 air mattresses. 3 times through a body-scanner, with 2 subsequent patdowns. 1 cancelled flight. 1 rented car. countless amtrak, light rail, subway, and bus rides. ah, the residency interview process. it's been quite a season. i started interviewing in november, did a month in the MICU (medical intensive care unit) in december, then spent the entire month of january away from home (see below). every one of my interviews, save one (my own hospital), were in locations that required a flight. i can't even describe to you how much i loathe airports at this point.



i will refrain from talking about which residency programs i liked best/details of interviews/etc at this point. look for an exciting post on march 17 about which program i've matched to! Or, feel free to talk to me in person. :)

for now, here are some highlights from the trips i took for the interviews. in addition to the excessive traveling i did in january (narrowly missing countless snowstorms, i might add), i also travelled in november. i picked a few pictures from a few places... especially ones henry came on.

pittsburgh, pa. where i grew up! here's a shot with my childhood street sign, and another of the beautiful downtown.


baltimore, md. the beautiful inner harbor.


chicago, il. plenty of snow and ice and cold, but loved every minute of it. at the ice-skating rink and "the bean" in millenium park.


new york, ny. the winter wonderland that is central park and ice-skating


lawrence, ks. not an actual interview location, but a short trip from st. louis and the location of university of kansas and my little sister! here's a shot of her with the beloved jayhawk and a lovely building on campus.


... what a whirlwind, but what fun! although i am happy staying put for a little while, i'm planning a few more trips for the end of 4th year - making the most of less responsibility before the ultimate responsibility of being an MD creeps up on me. :)

2011

happy new year! 2011 is going to be the best year yet. i can smell it. spent last night ringing it in with dear friends.

taken a few minutes after midnight: