In-N-Out

When I see the lines at the In-N-Out drive through (literally every one), I can help but wonder if all those people actually think this is the best thing they’ve tasted in their life, or if In-N-Out is a master of marketing and culture and have elevated their food and brand beyond a source of sustenance and into a symbol (a symbol of what I can’t say). It always blows my mind that people wait as long as they do for a meal at In-N-Out. Don’t get me wrong it is a decent burger and a great price (though looks like even they aren’t immune to inflation) and they do an excellent job keeping things moving despite the crowds, but to willingly subjecting yourself to 30 mins a car queue that is 17 cars deep seems a bit much.

3TITF
(1) Snake plants
(2) Self Checkout at Target
(3) People who use their blinkers

Surgery – Day 23

Weekend swing shifts are the best. No clinic, just rounds and floor work. Get to spend time with patients without having to go to the OR. Today we discharge one of the ladies who’s been on our service for pretty much the whole time I’ve been here. She was a very sweet lady and I was happy that she was able to finally go home. There was another guy on our list who was here longer that I have who we’ve been working on getting a wheelchair. It is surprisingly hard but we finally got one and we went to go work with him to get up and try it out. It was gratifying. Almost done with ACS, thank goobness.

3TITF:
(1) Being alive in a time of video calling.
(2) Cute puppies.
(3) Cozy sweaters.

Surgery – Day 21/22

It was a crazy one, and I got the trauma case I was hoping for. The majority of the daytime was relatively chill, but after around 4 pm everything started rolling in. Had some motorcycle accidents, falls, assaults, stab wounds. The big case was a gunshot wound to the abdomen. When we were all looking into this guy’s belly, trying to figure out it injuries it was almost reminiscent of a group project. Everyone had their own thought and suggesting of what to do. Different responsibilities were getting passed around and everyone was joking around despite the gravity of the situation. It was good kind of group project.

Another thing I thought about though was how many resources were pouring into saving this guy life. 4 people with 6 figure salaries, 1 student with 100k debt, countless (actually carefully counted) disposable and plastics just being consumed with reckless abandon. And I get it, we are trying to save this man’s life, so maybe it makes me a little psychopathic, but that’s just where my mind went.

It was a super cool surgery and glad I got to be a part of it. Overall it was a busy night in trauma, we didn’t even get a chance to rest our heads for a teeny tiny bit. Cheers to the last 28-hour call of the rotation (maybe of my life).

3TITF
(1) PIZZA
(2) Ethics discussions
(3) Layers

Surgery – Day 20

Pre-call day is always nice an chill. Though this morning I got to see a pretty interesting case. I didn’t get to scrub in because I guess it was a pretty difficult case so there was 3 attendings, 1 fellow, and a 3rd year resident all scrubbed in. They were placing an interpositional graft for a patient who had their carotid artery transected by a bullet. This was my first time seeing a thoracotomy and a thus a beating heart inside a living person’s chest. It was very cool (though I still think maybe the kidney transplant was a little cooler/ more interesting to me. That said this was probably a pretty rare case, also given that the patient had some unusual anatomy, an aberrant right subclavian artery.

Also later today I went to Target to get some deodorant and this older gentleman started talking to me asking if Old Spice was a good brand. We talked about deo for a while and then started talking about life and stuff, very nice guy, but also just a very random encounter (at first wasn’t sure if he was trying to sell me something or something).

Also got a chance to get dinner with my line, always nice to see them and catch up.

3TITF
(1) The consistent ones.
(2) Random shopping encounters with strangers.
(3) Cheesy fries.

Bitter

Coffee, beer, veggies, wine, dark chocolate. What makes us crave things that objectively leave a bad taste in our mouths? Is it the abstract knowledge (not sure if I’m using this term correctly) that their consumption has some type of desirable property outside of its flavor (i.e. stimulation, intoxication, health benefits, etc.) or is there something about the bitterness itself that we actually crave or is there something about these things that we seek out despite the bitterness and despite the their effects. I supposed it could be, and likely is, multifactorial as almost everything in this life is. Even when we subject ourselves to some form of physical or mental hardship (e.g. exercise, studying) there is both some form of direct and future reward that is motivating us in the form of endorphins and health/ vanity or the elusive flow state (neural mechanisms not well understood) and job prospects. Wouldn’t it be more advantageous to experience all these things as pleasant through and through? C’mon evolution! I guess that would make for a very boring life.

3TITF:
(1) Small, hidden, out of the way watering holes.
(2) Very large doors.
(3) My dad’s parallel parking formula.

The Option

Sometimes I wish my eyesight was just slightly not good so I could have the option to wear glasses. I always thought they looked cool, but I also realize that this is probably a terrible thing to wish for. So I guess I’ll just have to settle for wearing my blue light glasses in the privacy of my home and appreciate a more refined, intelligent looking Niko all by myself.

3TITF:
(1) Vision
(2) DIY YouTube channels
(3) Quilted blankets that aren’t too thick

Surgery – Day 18/19

This is the longest day I’ve had in medicine. I wanted to be on non-trauma today so I could be on the trauma service on Friday when I would expect to see more actual trauma. Today we were nonstop with non-trauma consults pretty much from pass-on (ends around 8:30 AM) through about now (2:00 AM the next day). It’s kind of gone by fast, but now that I have a second to rest the fatigue is catching up with me. I can’t wait to go home and sleep in 7 hours.

3TITF
(1) Fanny packs.
(2) Surgeons who don’t take themselves too seriously.
(3) Nurses who keep doctors in check.

Surgery – Day 17

Today was my first pre-call shift. The pre-call schedule is relatively chill. We start the morning as usual; getting numbers, pre-rounding, rounding, pass-on. Then our team goes to do the surgeries that are scheduled for the ACS teams, split into either trauma or non-trauma, with note-writing and orders and other various tasks sprinkled through.

On the non-trauma side there was an appendectomy. On the trauma side, we had a pretty gnarly leg wound debridement. I remember seeing the patient in the ED when we were on call just 3 days ago. She came in with super severe leg pain with imaging and labs concerning for a bad infection. I guess they debrided it the text day, and today she was scheduled for us to clean it out again. She had 3 big openings (made by the surgeons) going down the lateral aspect of her right thigh, each at least 6 inches apart, and 1 opening on the upper medial part of her thigh. Each one of these openings communicated with each other.

During the surgery I was able to feel the tense fascia that runs down the lateral leg (aka the fasciae latae) and was able to touch my finger coming in from one of the other openings. We had to clean out any developing clots from old blood that was collecting in there and also look for pockets of pus/ infection.

This poor women, must have been suffering for a long time for it to have gotten as bad as it was before coming in, and the recovery is not going to be easy, with her likely needing to return to the OR before going home.

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TTITF:
(1) You
(2) High-quality sunscreen
(3) The learning opportunities I get every day in the hospital and the residents, fellows, and attending who go out of their way to teach me something even if it means taking a little more time to do a task.

Thrive

Today we celebrated my aunt’s 60th birthday. Though we aren’t related by blood she has been a part of my life since I was just a wee lad. I’ve always admired her lively energy and her ability to bring joy and laughter with her wherever she goes. She has been through a lot these past few years, enough that would probably extinguish the spark of any other person, yet she remains a beacon of positivity and hope. Thrive on Auntie Rina ❤ I am very thankful to have you in my life.

Two other things I’m thankful for:
(1) Moments of silence that don’t need to be filled.
(2) Relationships that have reached the point of open vulnerability.

Surgery – Day 16

It wasn’t too crazy of a call shift thankfully, and I actually got to leave the hospital a tiny bit early because we had teaching that morning, but I am still counting it at the next day because (1) it literally involves the next day and (2) I spend more time in the hospital on my call days than I spent over multiple days on other services.

We had a sub-intern join us on service today. Seemed like a nice guy. He was from Loyola Medical School in Chicago. During some of our downtime there was some discussion about matching into residencies and all that. In our own school, admin has been preparing us to for what 4th year is going to look like. All this has just been making me a bit worried about matching for residency. I’m not sure how competitive of an applicant I am at this point. Definitely want to use these coming month to step up my game for Step 2, no pun intended.

3 things I’m grateful for:
Staff at places who are extraordinarily friendly, like you have no reason to be as smiley and friendly as you are being, but I am here for it.
Old rattley cars that still get the job done.
Banana split Dippin’ Dots only.