Chapter 3: Thoracic Surgery


Love, Sanity, or Medical School

Chapter 3: Thoracic Surgery

August 26: Monday

5:45 am: No other cars were on the road as I drove in. I meet my team at 6 am. It's weird being at the hospital before Starbucks opens. I'm nervous.

It’s so disorienting to start on a new rotation.

Four weeks of thoracic surgery here at The General Hospital. Thoracic surgery involves operations on the lungs and esophagus, typically to remove all or part of those organs due to the presence of cancer.

7:30 am: We had a two-minute orientation informing us that we’re not supposed to work more than twenty-eight hours in a row or more than eighty hours in a week. We were told to never make evening plans, because we may end up working late and then we'll be pissed. Plan on working until nine o'clock every night and that way if we get off at six o’clock, we'll be happy. Ok…

7:39 pm: I survived my first day, a solid twelve hours. Quite the change from outpatient medicine. As the medical student, my role is pretty straightforward. I’m to read ahead about the surgeries I will be attending, I’m to know the relevant anatomy, indications for the procedure, complications, and related whatnot. While in the OR, I watch the operation and if it’s appropriate, I close part or all of the incision or do other small tasks during the operation, while the attending supervises and points out anatomy or diseased tissue. The attending is in charge and the resident is “first assist”, aka the main helper. I would love to first assist because just watching an operation gets a little boring but unfortunately the surgery residents always get priority.

Today, I learned the elaborate ritual of cleansing ones body and soul in preparation for performing an operation. Surgeons work within a sterile field in the OR. The field includes the patient, and anyone or anything that may come into contact with the patient. In order to be allowed within the bubble of the sterile field, one must go through a series of sequential steps. The procedure, nearly religious in its solemnity and precision, starts with putting on a surgical cap, facemask, and eye shield. This is followed by washing your hands and nails thoroughly for three minutes, drying your hands with a sterile towel (starting at the fingertips and working towards the elbows), then donning an OR gown and two layers of sterile gloves, all without touching anything in the surrounding area. Once sterile, you cannot touch ANYTHING that is not sterile, or you will break the field and piss everyone off. Your hands have to remain between your shoulders and your waist, and you literally can’t put them down at your sides. Once sterile, you may approach the ceremonial operating room table.

The first case I scrubbed into involved repairing part of someone’s esophagus (the tube running from the mouth to the stomach). Almost immediately after scrubbing in and stepping up to the table, I developed an itch on my nose. Trapped in my sterile attire, I spent nearly two hours next to the OR table trying to rub the tip of my nose against my surgical mask in order to relieve the annoying sensation. No luck.

Another case involved placing a trach, or breathing tube, into someone’s neck. I learned that bleeding tissue is not always bad, because at least that means there is good blood flow to the area. Unlike zombie movies, dead tissue cannot come back to life. Simple. Logical. I like this surgery thing.

The nurses are really helpful here. In addition to being kind, they thoughtfully taught me about the magic of swabbing a bit of peppermint oil on your surgical mask before beginning a smelly surgery. Oh, and I like when they play music in then OR.

It's 9:15pm and I'm in bed. My alarm is set for 4:45 am. I'm forcing myself to stop writing and study a bit before I go to bed.

August 27: Tuesday

7: 25 am: It's amazing how differently surgery wants their patients presented during morning rounds. The entire presentation takes about one minute and notes are written ASAP. We see every single patient from 6-7 am, have a quick breakfast if there is time, and then we're off to OR at 7:30 am.

My surgery team is as small as my medicine team but we have just as many patients. We round so much faster yet get the same amount of work accomplished as compared to medicine rounds. Everything seems so much more efficient. Maybe I should be a surgeon.

A patient in the surgical ICU keeps yelling, “Ice cream! Ice cream! Ice cream!” Well sir, I would like some ice cream too, but you don't hear me making a fuss.

10:35 am: Every physician has one body part that they can't stand. I have yet to meet a doc without an aversion to at least one type of injury or illness. Popular dreaded subjects include eyeballs, feet, poor dentition, and hand injuries. Mine is mucus, or in laymen terms: boogers. I gag and nearly vomit whenever I see snot. I already knew this but I did not know the extent of my disgust. Today, I learned that my new least favorite thing in the entire world to do is remove nasogastric (NG) tubes. NG tubes run from a patient’s nostrils to their belly, and can be used for either feeding a patient or for suctioning their stomach contents. I will not go into detail about removing them because I will get nauseous again.

11:15 am: My surgery intern hates eyeballs.

2:05 pm: Today is our first day of surgery lectures. One of the surgeons, Dr. Mastermind, someone we have never met before, immediately starts posing questions after we sit down. He then looks at us, and starts calling on us by name to answer! Apparently he memorized all of our names and faces from the medical school directory so that he could look us in the eye and call on us the first day. Oh my.

A student is fumbling to answer one of Dr. Mastermind’s questions. After a moment Dr. Mastermind deadpans, “It's ok to make up answers, just say it with confidence.”

Dr. Mastermind is teaching us the secrets of surgery. He just quipped, “When in doubt, take it out.” I'm already a big fan of this surgeon. Turns out he works at The Private Hospital, where I’ll be rotating next for general surgery.

5:15 pm: Another thirteen-hour day.

The walls of the operating rooms are tiled a light blue, with the carefully arranged surgical equipment lying on sterile blue towels. The surgical lights reflecting off of the tiles and the array of metal tools gives the room a blue tint. I feel as if I’m underwater when in the OR. Swimming or drowning though? All the surgeons and nurses are gowned and gloved so that only their eyes are visible, making them appear to be in SCUBA gear.

The speed and efficiency of surgeons is daunting and impressive. The threat, no, not threat… the… the concern of seeing Casey throughout the day is annoying though. I feel like I'm on his turf.

9:23 and off to bed. Alarm set for 4:15 am.

August 28: Wednesday

4:55 am: The only people at the hospital are the overnight teams and third year medical students.

In just over two days I have already done more than I did on internal medicine. I’ve scrubbed into several surgeries, made calls, returned pages, given orders, removed chest tubes, done procedures, written progress notes, and completed other random tasks. My intern walks me through procedures or tells me what he wants done and then trusts that I will do it. I am actually being helpful to him and to the team (I think). Very refreshing.

6:03 am: A pale, frail, older female patient is wandering the halls of her floor. Her ethereal, floor-length white dress with flowing sleeves makes her look like a ghost. I wonder if anyone else can see her.

8:56 am: Post rounding. I’m at the thoracic surgery clinic today with the impressive Dr. Thorax. Most of the patients are here because they have new or suspected cancers. The physicians who are able to work in oncology amaze me.

10:58 am: One of my patients is a not-old-enough guy who has two separate cancers. Neither is curable without major surgery but to resect both would likely leave him without the ability to ever again speak or eat. His family asked the Dr. Thorax what she would do if it were her. An interesting discussing ensued about the complexity of the operations, the likelihood of complications, and the chance that he would have an acceptable quality of life at the end of it all. He hasn't made a final decision, but his initial thought was to take the pain medications we offered, not have either surgery, and live out the rest of his days enjoying time with his family. I think I'd do the same if it were me.

August 29: Thursday

4:55 am: It feels like I've been on this rotation for way more than three days because so much happens each eleven to fifteen hour day.

I never noticed before, but the staff elevators announce each floor in English and Spanish. The patient elevators are only in English. Strange, no?

Today, I learned that my inside white coat pocket comfortably fits an entire bagel. Score.

Yesterday evening marked Casey's last night here before leaving on vacation. By the time I return home tonight he will be gone and he won't return until September 10. After his trip, it will finally be time for him to pack up and move out of my apartment. I'm gearing up for a rough couple of weeks. At least I'll have my new roommate Zooey to distract me. She arrives on the fifteenth.

There is all of one patient in the clinic today. His lung collapsed a couple of days ago so he is here for a checkup. It’s not very common for a lung to spontaneously collapse in a young person but when it happens the patient is typically a really tall skinny male.

Twenty minutes later: Wow he is a personification of my textbook description of spontaneous pneumothorax in young males. In additional to being tall and skinny, he came across as very sweet and shy, too.

August 30: Friday

What a relief to not have to worry about seeing Casey all throughout the day. All the surgery teams changed today. My new team consists of a senior resident, a surgery intern, and a surgery physician assistant (PA). The senior resident is a friend of Casey’s. He is tall, friendly, and donned in classic green surgical scrubs, so his name will be the Jolly Green Giant, or JGG, for short. Everyone seems happy to teach and let me be involved. I already know JGG well because of Casey. I don't know the intern yet, but he is rumored to be kind, smart, and helpful. On a similar note, I have heard that the surgery PAs are amazing. All in all, I seem to have lucked out with my team.

Allegedly there is a ‘mystery bug’ at a nearby hospital that has closed their operating rooms until next Wednesday. Creepy. Every single operation had to be rescheduled. I can't imagine how bad of a bug it must be to cause the cancellation of five days’ worth of operations.

After finishing up at the surgery clinic this afternoon I got lost walking back to the main hospital. In the midst of my confusion I stumbled upon Dr. Neuro, sitting on a bench and eating a red jolly rancher. We chatted for a bit, discussing my surgery rotation and surgeons in general. Casey was brought up, followed by how poorly I may have done on my medicine final exam because I was so scattered in the aftermath of our break up.

This led to me almost breaking down crying on this random little bench somewhere on the hospital grounds. Our conversation basically turned into an impromptu therapy session. Dr. Neuro is such a calming presence to be around. His polite but inquisitive questions about my daily life caught me completely off guard. Out of necessity, I've been keeping fairly solid walls around me at work, but he marched right through them. It’s slowly dawning on me that I've been so busy I haven't really been processing all the change going on in my life. I'm really looking forward to having this weekend off to recoup.

I worked from about 5 am to 5 pm each day this week and totaled about sixty hours total for my first week on surgery.

Wahoo I just found out I don't have to come in on Monday because it's Labor Day and there are no surgeries scheduled. A three-day weekend!

August 31:Saturday

I think it is time to start changing out the photos in the apartment.

September 1: Sunday

11:05 am: Welcome to September.

I had a list of things to do yesterday. Clean my apartment, go food shopping, print out new photos, etc. Instead, I met up with my friend Callie at her apartment’s pool. We ran into a group of girls from our class and our quiet day catching up turned into an impromptu pool party.

The fun continued bar hopping downtown. One of the many fun things about hanging out with Callie is that she knows everybody, and she is an excellent wingman. My evening ended with a handsome blond ortho resident getting my number and texting me goodnight. Woke up today in a super messy apartment with no food in the fridge but hung over, tanned, and happy.

4:59 pm: With newly printed photos of a friends and family, I began the task of changing out all the happy photos of Casey and me. The first photo I took down had captured an adorable moment from when we saw Arcade Fire in Chicago a couple of years ago. The rush of tears came on so suddenly and forcefully that my hands were shaking and I nearly dropped the frame as I pulled the photo out. I pushed on. One-by-one I removed all the photos from our travels throughout the world over the past six years and eleven months. Memories from dozens of cities and events spread over three continents were placed gently in a neat little pile. The oldest photo I came across was a strip of black and white photo booth pictures from when we first met in Chicago. In the sequence we're smiling, then kissing, then looking at each other and laughing. We looked so happy. I was all of twenty-two and he was twenty-five years old.

Next came down the stuff on the fridge. It had been covered with save the date cards, wedding invites, and baby announcements from all of our friends that met, fell in love, got married, and started having babies. Because that is the normal way things happen. Most people don't just date forever.

Lastly, I replaced a piece of artwork I had painted for him last Christmas called Fenomeno by Remedios Varo, with another of my own recently completed paintings. It's a full-scale replica of Picasso's Las Meninas that I fell in love with when I saw it in Barcelona. Now I'm done. I can't handle anything else today.

Fenomeno Replica, Acrylic on Canvas

Las Meninas Replica, Acrylic on Canvas

8:37 pm: To cheer myself up I signed up for an online dating service. Why not? I don't think I'm ready to start dating but it would be a nice ego boost to get some attention online.

September 2: Monday

Labor Day. Upon moving into the apartment three years ago Casey painted the master bedroom green. Twenty minutes ago, I finished repainting it a smoky blue.

September 3: Tuesday

5:15am: Love wearing scrubs to work. Hate not seeing my friends because I work all the time. And today starts my first twenty-four-hour call day.

5:30 am: Unfortunately, the new patient on the census is the young man from clinic last week. His lung collapsed again over the weekend and this time the surgeons ended up resecting part of his lung. Now he's got all sorts of lines and tubes in him, including a chest tube, which is helping to prevent the remaining part of his lung from collapsing again.

7:30 am: Wow the music in the OR today is screaming heavy metal. Of all the possible tunes to be blasting out of the iPod of my super-efficient soft-spoken attending Dr. Thorax, heavy metal is definitely a surprise. In my humble third year medical student opinion, it's waaaaaaaaay too early in the morning for all this yelling!

Normally I would not be chilling in the OR typing away on my iPad but the current OR patient is undergoing a lung lavage. The patient has a lung disorder called Protein Alveolar Proteinosis, where their lungs essentially collect a lot of crap, making it difficult to breathe. For the procedure the docs repeatedly fill one of the lungs with water and then drain it, over and over again, to help clear out all the material that has accumulated. The process is then repeated on the other side. The result is in almost immediate relief of the majority of symptoms once the patient is woken up. Fifty liters of fluid will be used today and the process takes about six hours. It's pretty strange to think about the treatment objectively, though. The docs are essentially drowning the patient repeatedly. So here I am, sitting and studying (and occasionally typing) for a couple of hours. I wish I had a fleece though; it's freezing in the OR in just scrubs.

Several hours later: I’m an ice cube now.

Just passed Maverick in the hallway outside the surgery department and had a three second conversation. Awkward. Not him, me. He’s an emergency medicine resident, a stereotypical outdoorsy climbing type who always looks mildly mischievous underneath his curly brown hair. We met nearly two years ago, while volunteering for a medical school event and I always get stupidly flustered around him. Our conversation back then was nothing Earth shattering but something about his personality appealed to me, and I remember very vividly thinking, “if I were single, I would totally go for this guy.” The thought immediately struck me as odd because I never had any interest in cheating on Casey. Maybe in the back of my mind I already knew that Casey and I were in a dead end relationship? I wonder if Maverick is single now? Maybe Callie will know as she always has the best resident gossip. The Boss would probably know too, but I bet she’d kill me if I dated one of her residents. There’s no point in finding out though, I’m not ready to date yet anyway.

Terrifying Tuesday lecture. The surgeon is telling us about a shooting trend that happened a couple of years ago. A guy would call 911 and report that a man had been shot. The thing is, no one had actually been shot yet. The caller would proceed to wait, with a victim bound at his feet, until he heard the sirens of the approaching ambulance. Upon hearing the sirens the caller would then shoot his victim in the back of their neck, thus severing their spinal cord, and then run. The purpose of waiting to shoot was so that the EMTs would arrive soon enough to save the victim's life. Instead of dying, the victim would forever be paralyzed from the neck down. My stomach is churning.

10:50 pm: A senior surgery resident wandered over to me and reports, “There is a burn patient with over 90% burns covering his body. He is getting his dressings changed at 11 o'clock. You should go and watch.”

11:45 pm: I don't even know how to describe what I just saw. I had never seen a burn patient before. I walked into the uncomfortably warm room and surveyed the patient as the nursing team organized the materials for his dressing change. His arms and legs were covered in white bandages, thoroughly soaked with blood and seepage. The toes on his left foot poked out of the bandage, unscathed and healthy pink. His right foot did not exist anymore, having been obliterated in the fire. A white sheet covered his belly, held taut and stapled directly to his abdomen. His face remained covered in layers of white gauze.

A severe burn causes the skin to contract, which constricts the blood vessels and compromises blood flow. Body parts die without blood. To ensure adequate blood flow it's sometimes necessary to make incisions in the skin to relieve the pressure. Big, long strokes are needed wherever these contractures take place. Escharotomy is the word. At this patient’s hips, shoulders, and peeking out from the bandages on his extremities, you can see where the surgeons have intentionally split his flesh. Along the escharotomy incisions, shiny yellow fat and blood vessels strained to escape the confines of his dead grey-brown skin. The sheet over his belly covered a bag containing his intestines, which spilled out after the escharotomy on his abdomen.

I put myself in a position where I could be called upon to help if the nursing team needed an extra hand with the dressings. As horrific as this appeared to me, I wanted to help. It was the least I could do. I looked behind me to locate the nearest chair in case I felt faint. As the final preparations with his new set of dressings were finished being laid out I asked the simple question, “What happened?”

The nurses began unwrapping his many layers of gauze while sharing that he ran into a burning house to look for trapped occupants. Upon stepping into the house, a flashover engulfed him in flames. According to Wikipedia (my source for all things in med school), a flashover can reach over 930°F. His buddy was able to force the door open and pull him out mere seconds later. In those few moments, he sustained burns to essentially his entire body. And now here he lies in the burn unit. A moment after the story concluded, I was asked to help hold his leg while the nurses repositioned him onto his side. It felt heavy and warm in my hands. As I was holding his leg I couldn't help but think that his body already resembled the skin of the cadavers we dissected in previous years in medical school.

I don't have a lot of experience with nurses but the care they took in changing his dressings amazed me. I don't think I could ever do that on a daily basis. They are the kind of people I would want caring for my own family members.

When I asked about his prognosis a nurse whispered to me that they hoped his family would choose to revoke life support.

12:16 am: So now here I am, in my bitty little call room that looks like an ancient college dormitory (or a prison cell, depending on the angle). My roommate for the evening, one of my classmates, got right into bed and seemed to fall asleep easily. Not me. I had to process what I just saw. My hope for the burn patient is that he is well sedated and feels loved and is honored for having his last conscious moments on this earth spent trying to save the lives of others.

4:30 am: I hate my alarm clock. And waking up in a call room is weird.

5:38 am: I already pre-rounded on my patient so just rounds and then home hopefully by 8 am. I'm excited to go home and sleep in my own bed for a bit; away from the cancers, the traumas, and the burns at the hospital.

September 4: Wednesday

Slept in and then spent the rest of the day working on my apartment, cleansing the rooms of Casey’s presence. I didn't move apartments, but I want it to feel and look as if I did.

September 5: Thursday

How is it Thursday already? I'm so confused with these days. So much gets accomplished every day that it feels as if I've been on surgery for weeks already, not eight days.

The tall thin young man may be discharged today. Hopefully no more pneumothoraces for him.

September 6: Friday

5: 02 am: Woke up in a weird mood, I think I dreamt about Casey last night. Happily, I will be in the OR all day. Like literally ALL day, as there are big surgeries today. Need to get my game face on and not look mopey!

4:18 pm: I scrubbed into an esophagectomy today on an older gentleman named Professor Z. Basically the operation is exactly what it sounds like: they take out the esophagus and connect the pharynx directly to the stomach. It's amazing to watch surgeons open people up, rearrange their insides, then put the person back together.

JGG is planning to go out of town tonight and he is practically jumping out of his skin to leave. To his dismay, a patient unexpectedly developed a pneumothorax while at the same time a new ED consult arrived. Just as our clerkship director warned us; don't make plans for 5 pm.

The surgery intern and I bonded today. He skipped lunch because he was too busy, so I shared the peanut butter crackers that are always stashed in one of my fifty white coat pockets. While munching away he confided in me that he doesn't like the days when JGG is trying to run out the door, because he doesn't feel confident enough yet to be left solo. I could see his frustration and underlying concern about being here alone if something bad happens to a patient. I wonder if seven years as a surgery resident will morph him from being a super nice guy into someone cynical and bitter. I hope not.

September 7: Saturday

I love sleeping in and waking up feeling refreshed. I’ve been getting emails from the online dating site and one caught my eye. A tall, fair, blue-eyed resident name Dr. Spengler struck up a conversation. Seems great on paper. I emailed him back.

September 8: Sunday

10:45 pm: First night in my new bed. When Casey moves out he’ll be taking our bed with him, so I had to order a new bed for the master bedroom. My room. I’m sitting with my iPad right now, but it’s not the same as writing on paper. I miss my journal. Writing with the knowledge that someone someday may read my words changes how I put them down. I am trying to be clearer and more deliberate with what I write as opposed to my usual stream of consciousness ramblings. Time for sleep.

11:15 pm: Sigh. I’m still struggling and having trouble sleeping. I can’t think about Casey yet because I still get angry, sad, and lonely, often all at the same time. Other than work, studying, and redoing the apartment, I am attempting to meet new people. There was the one from the canoe trip and the ortho resident, neither of which I followed up with even though both have been texting. Either could be a fun rebound but I don’t know. I’m not ready. I really have to go to sleep. My alarm is set for 4:30 am. Ugh.

September 9: Monday

Professor Z seems to be doing well post esophagectomy. His kind nature and good spirits are already well known and appreciated amongst the surgery team. Walking into his room today I was greeted by an array of stunning, brightly colored bouquets. One bouquet contained a variety of bright orange flowers (my favorite color), another featured red roses, and a trough shaped vase near the window overflowed with blue and purple flowers accented by a couple of peacock feathers. Clearly, I'm not the only one who enjoys his company. He seems to have quite a few admirers.

During a free moment I slipped into a daydream about the random summer I worked at a beach in California. Memories of the warm weather, the sunshine, the sand between my toes, and the cold surf vividly filled my mind. My paged began wailing and jolted me from my reverie. I have to figure out how to obtain a wound vac. Wound vacs (short for vacuum) are suction devices that are placed over wounds and literally suck out fluids like blood and pus. Gross. One of my difficult patients developed a purulent, malodorous, nasty, boomerang-sized infection on her back and needs one now. Surgery is really good at ruining nice daydreams. Back to work.

I'm sitting awkwardly close to a fourth-year medical student who asked for feedback from a senior resident. The resident coldly replied, “You are very smart, you have a lot of book knowledge, but you need to work on your common sense. You need to learn to think and organize your brain before words come out of your mouth.” Oh wow. There was more to that conversation, but not much. Surgeons certainly don’t mince words.

September 10: Tuesday

Casey returns today. He will be back in my apartment by the time I get home from work.

I walked down the surgery hallway a minute or so after a gunshot wound victim was wheeled from the emergency department to the OR. The patient bled so profusely that the hallway, where the patient rolled through, had a vibrant trail of blood down it and the air had a metallic smell.

My internal medicine exam grade is in. I’m freaking out. We can ask for our grade through email but I'm going to go check in person because if I failed, I don't want to start crying in the middle of the surgical ICU.

30 minutes later...

Ok so not only did I pass but I scored high enough to qualify for high pass or honors. The secretary at the internal medicine office, Ms. CV, must have sensed my relief and shock because she looked at me quizzically and then asked me if I was ok. My incredibly logical response to her query was to start crying. What is wrong with me? I swear I'm not a crier. She gave me a hug and we chatted while I calmed down. We sat for nearly twenty minutes and discussed life and love while I ate a pack of Smarties from the stash that is always at her desk.

Ms. CV told me about when she was young and naive and dating the wrong guy. She realized he was the wrong man for me, but carrying out the decision to leave him was a terrible experience for her. But, she added with a grin, she then met then right man. She and her husband are about to celebrate thirty-four years of happy matrimony together. It's amazing how someone taking a couple minutes out his or her busy day to sit and chat with you can cheer you up.

3:28 pm: Tuesday lectures. My favorite quote so far today came from a pediatric surgeon who implored, “You should be passionately connected to the care of your patient.”

3:45 pm: Magnus must be bored because he keeps texting me random memes.

September 11: Wednesday

6:11 am: At what point does it transition from being called break-up sex to just having sex with someone you used to date?

8:20 am: I have a rare peaceful hour and a half before I have to be anywhere so I’m relaxing on the front steps to the medical school, enjoying the sunshine. I immensely dislike being indoors in windowless underwater operating rooms all day. At least I get to do my surgery rotation in the fall. The winter students rotating will arrive before the sun is up and leave after it is down every single day. Can you imagine only seeing sunlight on weekends?

Today is September 11th. There are a lot of people hurting today and I feel their pain. Most of the day I will avoid watching television, because 9/11 coverage still makes my heart ache. I was seventeen years old, sitting in third period math class when an announcement came over the loudspeaker that a plane had struck the World Trade Center. I had a moment of panic, knowing that my father worked mere steps from the Twin Towers. My teacher rambled on about numbers to a progressively uninterested room of students until the bell signaled the end of class.

My fourth period American History teacher brought my class to the library, where increasing numbers of students were convening to watch the coverage live. I sat in a daze on the open winding staircase between the first and second floors of the library, unsure what was going on. We silently watched the news unfold, with a collective gasp and cry when the first tower fell, sick with knowing that some of our family members were inside. I couldn’t reach my dad but was able to get in touch with my mom. She informed me that my dad was okay but then revealed how his phone had gone dead mid-sentence as the first tower collapsed, her overly calm and measured voice betraying an underlying strain and rising anxiety.

The school tried to corral all the students on school grounds but my friends and I snuck out a side door and drove home. I paced my bedroom, journaled, and called every family member I could think of to see if they had heard anything else from my dad. I felt rage for the first time that day, the event inciting anger and hatred towards those responsible. I also felt fear, but mostly I experienced an overriding sense of helplessness. I had no skills, no ability to help, and no power to do anything useful. After pacing tracks into my carpet for nearly eight hours, my father finally turned up safe and sound at our house on Long Island.

These days on 9/11 I cry not only out of sadness but also out of fear. My parents, my sister and her husband, and now my newborn baby nephews, all live blocks from each other in midtown Manhattan. The rest of my family, including all of my aunts, uncles, and cousins, live in the major cites of Washington, D.C. and Boston.

Terrorist attacks and other catastrophes are out of my control, so I try not to dwell on them. I'm usually pretty good but sometimes it's hard. I've had nightmares about being inside a collapsing building; seeing the walls shake and debris start falling. I wake up crying and won't be able to shake the post-nightmare haze until I hear my momma's voice. So yes, today will be spent avoiding television. I've been a bit fragile when it comes to triggering the waterworks these days and breaking down about 9/11 while I'm at work sounds awful and embarrassing. I will do a quiet, private reflection and remembrance when I get home later tonight.

8:45 am: The unmistakable sound of bagpipes playing Amazing Grace started filling the air. Looking around, I spot a 9/11 memorial going on atop the building across the street. There are people lined up on the roof, removing their hats and placing their hands over their hearts. Just lost it. I'm outside the medical school building crying. So much for waiting until later for a private moment.

9:26 am: Back inside the College of Medicine I went to the bookstore to get a snack after washing my face in the bathroom. One of the internal medicine residents with whom I'd become friendly saw me and without a pause commented, “Hi, oh, you look tired.”

I simply replied, “Oh yes, I'm on surgery.”

No other explanation needed. In reply I got an encouraging, “Hang in there, it gets better!”

Yes, I am tired and my beautiful green eyes are not looking their best at this moment. My eyes have bags under them from staying up too late having sex with my ex-boyfriend and that fine tint of red and swelling is due to sitting outside crying about 9/11 less than an hour ago. Stating that I looked tired just because I'm on surgery seemed easier and unquestionable.

It really has been a quiet morning, I'm not used to this on surgery. I've already written so much today and it's only 9:48 am. For having not done much other than rounds and make phone calls this day already feels too long.

In a surprising turn of events there were more residents than patients at Dr. Thorax’s clinic. This means my only job is to take out about a billion staples from an esophagectomy patient, whom I had followed during my first week on surgery. It's nice to chat with him and his wife and to see that he is doing so well after such an intense surgery.

September 12: Thursday

I enjoy starting off my days visiting… um…. I mean pre-rounding, with Professor Z. He is always in good spirits. Each day his voice gets stronger and he gets chattier.

After rounds each morning we visit pre-op patients that are scheduled to go to the OR that day. There is only one patient today. She is an elderly lady named Primadonna, who is having a suspicious looking nodule in her lung removed. This may unfortunately turn out to be cancer. Here she is, lying in her pre-op bed, gowned and ready to go for surgery, awaiting a possible diagnosis of lung cancer, and she is sitting and puffing away on an e-cigarette. Talk about addiction. I wanted to take a photo of this woman. She held onto that e-cigarette until the nurses started wheeling her out of the room to go to the OR, at which time she reluctantly handed it off to her daughter.

I told a resident how much I envied the surgeon’s efficiency. He replied, “They don’t pay us more to work harder.” In terms of being paid, considering how many hours surgery residents work, they make less than minimum wage if you do the math.

I’m about to leave Dr. Thorax’s clinic. There was another third-year medical student at clinic today too. I examined, presented, and wrote notes on six patients this morning. The other medical student saw one patient. One. What on Earth did he do all morning?

Still been emailing back and forth with the online guy, Dr. Spengler. I think we may actually go out on a date soon.

September 13: Friday

While pre-rounding on Professor Z today I learned that he has recently retired after being a professor for over forty years. Now that he is retired, he has decided to focus on his writing. We talked about his job, life in the hospital, and recovery after illness. He does not like being out of control of what is happening to him. Completely understandable. He is most looking forward to a shower and the Starbucks coffee that his friend is bringing him later this afternoon. He joked about his hair being messy from not showering but he supposes that this new look is apropos to his burgeoning career as a writer. I'm thrilled he is doing so well but will miss our morning chats when he leaves the hospital.

September 14: Saturday

September 15: Sunday

5:13 am: The hospital is creepily quiet at 5 am on Sunday mornings.

Zooey moved in yesterday and I’m yet again on call so I won’t have a chance to help her get settled.

6:02 am: There is a pleasantly demented man in the surgical ICU that constantly calls for his nurse. I keep hearing, "Nurse! Nurse! Nurse!" Pause and repeat. He isn't exactly yelling; his voice has an operatic quality and he bellows the word as if it’s an aria being performed at the Metropolitan Opera House. He is closely tended to in the ICU and is not in any distress or pain, he just keeps singing whenever his nurse leaves the room. The overnight team informed he was like that all last night too. In the most complementary and respectful way possible, I will call him Operaman.

I pre-rounded on e-cigarette smoking Primadonna and let me tell you, she is the most miserable and nasty patient I have met so far this year. She let me know how bothersome it is to have nurses and physicians checking in on her. Lots of F bombs and degrading comments that always start with, “You people...” I'm pretty sure she believes we are trying to torture her. She is mad that she is coughing shit up but after chain smoking for forty-five years it’s really not that surprising but somehow, it's our fault. Her lack of insight and empathy is shockingly profound.

12:00 pm: I've been here six and a half hours and Operaman is still going at it.

2:45 pm: Still yelling. It’s been busy today but not too busy, and the ICU is calm at the moment. I'm gonna go chat with Operaman.

3:45 pm: What a nice guy. First, I asked Operaman about his pain. He informed me that no, he wasn't in any pain and that his nurse is wonderful. He told me about where he was from, and what he did for a living. He has a lot of children and has lost track of how many grandchildren and great grandchildren he's got at this point. He kept looking at me and repeating, “Thank you for coming in, it gets awful lonesome in here.”

6:00 pm: Thirteen hours down, thirteen hours to go...

7:50: Operaman started up again so I sat with him for a bit and we discussed football and watched the Broncos-Giants game. I told him I needed to go study, but I promised to come back and visit later. He promised not to yell in the interim. Five minutes later he started singing again. As part of his dementia I'm guessing he probably has a pretty poor concept of time.

9:20 pm: I sat with Operaman a bit longer. He wanted to hold my hand while we chatted and appeared sad that no family visited him today. He asked me if I could stay and be his doctor, which was very sweet.

September 16: Monday

Zzzz.

September 17: Tuesday

1:36 pm: Tuesday lectures. I spent four hours in the OR this morning. Surrounding the operating table was the intern, the senior resident, the attending, the scrub nurse, and a pulmonology fellow. That is a lot of people doing very delicate work in a very small space. Dr. Thorax was nice enough to let me scrub in, but I could not get anywhere near the OR table. I stood nowhere near the operating table for four hours. I basically stared at the back of JGG’s scrubs, trying to not break the sterile field. Of those four hours, I spent about two and a half of them thinking about what I will wear on my date with Spengler tomorrow night. It's my first first date in forever. I’m guessing it’s like riding a bike. From an academic standpoint, I learned that I am capable of falling asleep standing up.

1:43 pm: Tuesday lectures. Trauma lectures have the best images. Evidently not every student in the room is looking at the gory images from the PowerPoint because the surgeon is currently screaming at my classmates, “Make sure you look at that picture. Look! Look at it!” These surgeons are way too intense for me. Relax man. Take a deep breath.

2:15 pm: A calmer surgeon is now lecturing. He is stressing the importance of asking the right questions in order to reach a diagnosis. He claims that 80% of diagnoses can be made by history alone. Interesting.

3:01 pm: The third out of four lectures just started. I am so painfully tired today. I slept all day yesterday because I was post-call, and then couldn’t sleep last night.

4: 05 pm: My favorite surgeon, Dr. Mastermind, is lecturing again today and offering some gems of advice. “Whenever there are two ways to do things, that means neither one is perfect.” Plus, “Sometimes surgery doesn't work out perfectly, but as long as you do the right thing, it's ok.”

September 18: Wednesday

I can't help but feel mildly insulted when the JGG is surprised that an exam finding I report to him is actually present. Today he remarked, “Oh look, there really is a small air leak with cough on Ms. Primadonna's chest tube.” I swear I don't make things up. I really do arrive at five in fucking morning every single day to pre-round on my patients.

The highlight of rounding today involved being pimped and randomly knowing about Takotsubo cardiomyopathy (aka Broken heart syndrome), which led to Dr. Thorax announcing that I am “one of the smart ones.” I didn’t reveal that I learned about it from watching Scrubs.

My new roommate Zooey texted me, “I haven't seen you in a couple of days, everything ok?” Yep, I responded, just been practically living at the hospital. Zooey seems so sweet; I wish I had time to get to know her better.

On the flip side, I can't believe Casey hasn't moved out yet. Ostensibly, there are some delays in finishing the new apartment into which he is moving. I still like having him around, so I haven't really been forcing him out the door either. I know I can't move on until he leaves though. What's worse is now that Zooey moved in, Casey and I are both sleeping in the master bedroom. Great planning, right?

I’m exhausted. Been falling asleep on rounds and in lectures all day. I’ll be rushing home soon to change for my date with Dr. Spengler. Fortunately, Casey is on call tonight, so I don't have to awkwardly leave my own apartment wearing a skirt and heels on a Wednesday night.

11 pm: Great date, must sleep now.

September 19: Thursday

5:15 am: How is it already September 19? Last time I checked it was the end of August. I caved and went to work today for the first time ever with zero makeup on. I needed five extra minutes of sleep. I feel like a true third year medical student now.

7:20 am: At some point I’ll write about my date last night with Dr. Spengler but I have to focus on prepping my presentation on Barrett’s Esophagus that I am giving tomorrow night.

8:25 am: I'm back at Dr. Thorax’s clinic for the last time.

Today marks the first time I've cried with a patient. I requested to see this particular patient because I had worked with him in clinic two weeks earlier. Upon entering the room I see an anxious looking patient with watery red eyes sitting on the exam table. I hesitantly ask if he is ok, (which by now you know is the easiest way to make someone cry), and the patient immediately bursts out sobbing.

I sat with the patient for a while and once he calmed enough to talk, he told me that his child died yesterday. The patient sobbed and cried out for their lost loved one. Stunned and shocked, I regretted that I had nothing to offer my patient in terms of words of solace or comfort. What on Earth could you possibly say to a parent who lost a child not a day earlier? I simply sat there, held his hand, and cried too. The patient was so distraught that he didn't think to cancel or reschedule his appointment. After I informed Dr. Thorax of the situation, she too went and sat with him for a bit.

1:08 pm: Upon getting ready to leave Dr. Thorax thanked me for my help, told me I have solid surgery skills, her door is always open, and that I should come speak with her before the end of the rotation. Success.

7:30 pm: Home from work, ate a quick dinner, and now it’s time to put together my presentation for tomorrow. My goal is to be done by midnight. That gives me four hours of sleep... again. Can people die from exhaustion?

September 20: Friday

5:30am: Today should be my last day on surgery but since I'm on call, technically my last day will be tomorrow. I can't believe I've survived half of my surgery rotation already. I'm absolutely wiped.

I stayed up all night writing and editing my Barrett's Esophagus presentation. I haven't gotten much sleep any night this week. Once again, I’m too tired to put on makeup. I’m not talking about a lot here, a little under eye concealer, a swipe of Urban Decay Sin eye shadow primer potion, a thin line of bright eyeliner and some mascara, all in all about three minutes of my morning. It’s not much but I enjoy spending three out of the 1440 minutes in my day focusing on myself.

7:00 am: My presentation got pushed back because Dr. Thorax isn't here today. I don't mind though I wish I had known last night because I'm going into a twenty-eight-hour call day running on fumes.

1:05 pm: I now have a random free hour (because I no longer have to practice my presentation) so I'm sitting with my pumpkin spice latte, catching up on emails and paperwork. An email arrived from Ms. CV, the secretary from internal medicine, letting me know that she was thinking about me and asking how I was doing. Another email featured a ton of adorable photos of my chubby baby nephews. This afternoon turned out so lovely! Too bad I can't leave the hospital for at least another seventeen hours.

A couple of minutes to talk about my date with Dr. Spengler. I experienced instant relief upon seeing him, as he actually resembled his photo. Overall he is tall, cute, super sweet, nerdy, and quite chatty. Throughout the date I sat there obsessively thinking, “oh wow, I can’t believe I’m on a first date with someone” and wondering if people would look at us and think, “I bet they're on a first date.” Weird, weird, weird to be on a first date! We totally hit it off and had a great time. He didn't kiss me goodnight. Pussy.

I ran into another medical student and he immediately commented, “You look tired, you must be on surgery.” I give up. I will wake up three minutes earlier in the morning and resume doing my makeup. I made it a whole two days without makeup. As an aside, please don’t ever see someone and tell him or her they look tired. Seriously. Just stop.

4:00 pm: My day is getting better and better. Since the patients are all calm and stable I can take a nap. It is blissfully quiet and cool in the call room... Zzz.

5:15pm: Hands down the best nap I have EVER taken. I feel mildly human again.

I can’t believe this part of the rotation is almost over. Way more my speed than my medicine rotation. I did a ton of suturing and stapling, improved my surgical skills, and took the chance to get my hands dirty as much as possible. I love doing procedures, though I do miss having time to sit and chat with my patients. The surgeons were welcoming and encouraging, if not a little high-strung at times.

September 21: Saturday

4:10 pm: The rest of call wasn't very busy or exciting. I scrubbed into an appendectomy and passed out in my call room bed by 1 am. Unfortunately I awoke at 5 am to prerounds, and couldn't leave until after rounds concluded, sometime around 9:30 am. So that made for a thirty-one-hour shift, clocking in at a grand total of ninety-six-hours this week. Wait, I thought I'm not allowed to work over eighty hours a week? Don't worry, as long as my weekly totals average less than eighty hours then the occasional 96'er is kosher. Fucking loopholes.

Next up, off to The Private Hospital for general surgery. All I've heard about rotating there is that the hours are worse.