Hahnemann Part Two

It was inevitable— Hahnemann University Hospital was going to close, and so was our Emergency Medicine program.

A bit of history about our program. It was one of the first EM programs ever. It was founded in the early 1970s, when Emergency Medicine was just a new field. Dr. Dave Wagner. Dr. Jim Roberts. We had a running list of all of the great names that started the program and trained in the program. It had hundreds of alumni around the nation.

And just like that, it was going to close.

And here I was. Fresh out of heart transplant surgery. Just about to show the world that I could do it again. With no place to do it at.

So, we were told to start looking for new residency programs. We were going to be residency-less. In the medical world, this = “orphaned” residents.

By the way, right around this time, I felt like DeMarcus Cousins after his Achilles’ tendon rupture. I was Alin, right after my heart transplant. Hahnemann was my original team; they knew me. But I was a free agent now. The other teams (residency programs) knew that I was probably good, and respected everything that I had been through, but could they have taken a chance on me? My heart was my Achilles’ tendon, my fate was in the hands of the NBA draft— uh, ReMatch 2019.

I was DeMarcus Cousins.

And I had to think positively.

I kept telling myself: I had already matched into a wonderful Critical Care Medicine fellowship program— one of the toughest, best in the nation (and that was the most ironic part of my whole story … that I had matched into an ICU fellowship just weeks before becoming an ICU patient, remember?). I was projected to start July 2020. So all I needed was a place to complete my last few months of residency. My procedures had been signed off. Almost everything had been done. I just had to finish my shifts, take my boards. Move to New York City. And get on with this shit. I had to move forward.

Furthermore, I had to stay in the Greater Philadelphia area to complete my residency— it would be ideal if I could continue my heart transplant care at UPenn (for at least this first year).

Luckily, there were many three-year EM residency programs in the area-- this was going to be easy. I had great evaluations, tons of research, I was literally almost done w residency, and I obviously had some sort of decent application— I had gotten into fellowship with the same application. If anything, I had added a few more things to my CV since my heart transplant.

This was going to be easy. Easy peasy.

I interviewed at a few Philly-based EM programs. In total, there were over 500 residents who were going to need spots in various specialties and most of them wanted to stay in Philadelphia. From these 500+ residents, 46 of us were specializing in Emergency Medicine.


Anyways, interviews came and went. And I waited and waited for some sort of offer from any of the seven nearby programs. ONE would surely take me. A few of them seemed pretty excited to have me as a potential resident.

And so I waited for an offer.

And waited.

And...

No.

No offer.

Of course.

So there was my third battle of the summer. I became one of the few residents who did not find an easy residency spot in the city. And I legitimately needed a spot in the city. Like, legit, legitimately.

I wasn’t very open about my third battle. I was ashamed of my third battle. I was so upset by it that I remember I stayed in bed for 24 hours on that Thursday, something that I never, ever do. I didn’t say a word to anyone. I took a Benadryl by 9pm that night, and just went back to sleep in the bed that I had laid in the whole day.

Because there was no f&%$ing way that not one thing couldn’t go right for me this year.

I was so sad that I couldn’t even be angry or sarcastic about what had just happened. I was so sad that I couldn’t even call my friends or my parents.

I didn’t find a residency spot in Philadelphia. What did this mean for me?

  1. I was told that these programs would automatically take me because of my situation and my need to stay in the city. I trusted the people around me. I didn’t transfer my heart care to any new hospital system. This will take weeks to do if I have to move.

  2. If the program closes tomorrow, I have no program to get transferred to. Thus, no health insurance. Will I have health insurance benefits for the next few weeks while I search, since my employer is filing for bankruptcy?

  3. I just got off of medical leave. No more COBRA for me. Can I go back on COBRA?

  4. If I have no health insurance, how will I pay for my expensive medications this month? I think Tacrolimus costs thousands of dollars.

  5. When is my next Tac refill?

  6. Do I need to reschedule my Cath?

  7. What if I don’t find a residency in time and just never finish residency?

  8. What if I just never find a job ever again? Should I have been more private about my transplant?

  9. Is this the third sign just honestly telling me to give up on everything?

You know, I even remember thinking the darkest thought of all:

that this would have been so much easier if I had just died in December.

Because dying in those few seconds during that winter evening, when everything in my head was really peaceful and calm (I still remember just those last seconds vividly "should we just turn it into a code")— that would have been much easier on my heart than having to go through sudden transplant surgery. Months of quarantine, anxiety, setbacks. An episode of acute rejection. Biweekly cardiac catheterizations. Weekly lab draws. A residency program closure. Anger. A rising creatinine level. Loneliness. Stress. Unemployment. Worry.

Constantly hoping for the best, expecting the worst, and then just being handed the worst.

Was this my breaking point?

People kept asking me how I hadn’t reached my breaking point yet. “If I were you, I would’ve killed myself by now!” (which is also a terrible thing to say to someone, by the way)

Well, you aren’t me. And if by all that you mean, “How the hell are you handling all of this?” I didn’t choose for any of this to happen to me. So it hurts me when you say that. I am trying my best, and I don’t want to kill myself, and maybe you shouldn’t say that to me. It doesn’t make me feel stronger. It just makes me feel like my life is not worth living. And to say that to someone who’s been given a second chance to live … you just wouldn’t know how that feels.

And I just wish one f&^%ing place would’ve taken me here in Philadelphia.

Ugh.

I fell asleep with the most negative thoughts in my head. I felt some palpitations. I had a migraine headache. I don’t think I even ate that day. And I didn’t even care.

I woke up on Friday morning, still a bit sad. Groggy from the Benadryl. I took my morning medications, looked through my emails to make sure that no program truly wanted to make an offer for this poor transplanted PGY3 who was almost done with residency (nope).

I wasn’t as sad that day; I was just bitter. Angry. Ready to figure out why I hadn’t gotten an offer.

But then I found out that a lot of my third-year co-residents also hadn’t gotten offers. Many of them were struggling for their own reasons. One of them had just had a baby, had just bought a house in the area. One of them had already transferred residencies one other time— his previous residency program had also closed (his luck was just as bad as mine, we had decided). Actually, a lot of us had had really sad Thursday nights. Our attendings called us, talked to us. Our co-residents sent us positive messages. Friends and family told us that everything would be okay. (Worst thing to say, btw, just don’t ever say that to anyone.)

Everybody wanted to help. The only problem was that, well, nobody knew how to help.

We didn’t even know how to help ourselves.

We went out for some food, beers. We cried. We hugged. We were all so helpless, even those who had found residency spots.

“It’s not gonna be the same. I’m gonna be alone with random people. And we’ve always been the misfits around here,” one of the residents said.

“I just feel weird because everyone keeps saying that they want to help us and I just want to be, like, all right then get me into your freakin’ program and make it into Drexel EM and we’ll be good,” I said.

And don’t forget. These people weren’t just my co-residents. They were something else for me. My life had been saved at Hahnemann. I had died in one of those rooms, and it was the Drexel EM, IM, Surgery residents and nurses who saved my life that first time. My first ever central line had been placed by the Drexel Pulm/Crit fellow. The Drexel Cardiology team had first taken me to the cath lab.

Nobody would ever understand the emotions that I felt during the summer of 2019.

And some of us still needed to find a hospital to finish our training at.

We could hate that CEO who decided to shut down Hahnemann all we wanted. But the system let this happen. I couldn’t blame him for my migraine and my palpitations. My co-resident couldn’t blame him for now having to sell his house in Philadelphia to move elsewhere. And that was just us. Remember, this closure affected our patients, too. Where would they get their care? And now, the nearby hospitals were going to become more saturated— longer ED waiting times, worse outcomes for hospitalized people. This whole thing was a complete catastrophe for all of us.

Anyways … why didn’t I get an offer in Philadelphia?

I knew that funding would have been an issue with me (a resident with just a few months of residency left … this is too complicated to explain, but trust me on it), and that I was “off-cycle” (aka a “headache” with paperwork, boards, everything in between for a program director). Maybe my scores sucked. Maybe my evals sucked. Again, I have no idea. If I had gotten into a fellowship program with that application, then no, I don’t think so, but who knows.

And was my health an issue? Who knows. Probably. But what was I supposed to do? Delete my blog and hope that nobody remembered me ever again? I was a bit unforgettable at that point, I assumed. And I was glad. Good. Unforgettable and proud. If I was going to be unemployed for the rest of my life, then at least I had made a difference in the world of organ donation. So be it. Bye, Felicia.

I called my Transplant Team. And, of course, I was overly dramatic as usual. “So basically I’m unemployed AND immunocompromised and I am so upset by this whole thing and UGH…”

It was true. I had no job. I had no immune system. I probably had no health insurance.

My social worker helped me out a lot. We were able to get me extra prescriptions in case I ran into insurance issues. People were worried about not re-matching into their top choice residency programs and here I was worried about, like, making sure that I would be able to stay alive another month. Which I thought was hilarious. Good, my dark humor was coming back.

She offered to call the ACGME, even nearby programs, to see if we could get something figured out. I had some special (critical) circumstances related to my health, surely something could or would happen? I told her not to get her hopes up.

Over the next day, my sadness turned into anger. Turned into rage. Turned into pure energy to figure this shit out asap.

“Resilient” was my middle name. (See my first post that I wrote on post-op day 7. S/p heart transplant surgery.) Ha. This was just another Inconvenient Life Event to add to my year. And I was going to embrace it.

I wish I could tell you that the most magical and craziest thing happened that miraculously placed me into a nearby residency program.

But what actually happened was that during that weekend, I just decided to Google the words: “residencies near Philadelphia.” And I just decided that I would email every single residency program director around the area.

Was this cold calling? Unprofessional? Walk a mile in my shoes— you would’ve done the same.

I got around to emailing one, something along the lines of:

“Hi. My name is Alin. I need a spot for last few months of residency. I have a heart transplant (done at UPenn), must stay in area. You might know me. But I had goals before the transplant as well. Already have fellowship for July. I have a beautiful CV (attached). Kthxbye.”

I spoke to the program director the following day. As it turned out, he did know about me. As it turned out, he was starting up a new program and was very open to taking a few of the Hahnemann residents. Because of my interest (uh, Google search & desperate email), some of us actually ended up interviewing there.

The next day, he called me and asked, “So this is me formally asking you, if you’d like to join our program?”

And I remember telling him, “AHHHH this is the best phone call, well, second best phone call of this year! You saved my life! You’re right up there with the phone call I got about my heart!!!!!!! I’m so in! I’m in! This was like LITERALLY the worst week of my life, well like the second worst week of my life next to that one time when my heart stopped….”

And he was just laughing on the other line. And I was laughing. And just like that, in the strangest way, it worked out. I was in the lobby of my apartment building, and everything felt okay again.

He even made me Chief Resident, coming up with a plan on how I could do part-time admin/clinical duties simultaneously, as that would be much less stressful for me (and my health) at this time.

He was more than flexible with my health needs. “Sorry, I get labs drawn like all of the time, but I won’t miss any conference days for them.” That was no problem for him.

The whole program, including the other faculty and residents, were very welcoming.

So I ended up at UPMC Pinnacle with my co-resident. (A train ride away, but close enough. I mean, what can I do?) … I’ve been there for a little over a month now, and everything has been going well so far. Plus, I have funny stories to share about what it’s like using public transportation again as a transplant patient.

Also, I got to keep my Transplant Team at UPenn. And I love them to death because they saw how much more stressed I was about the Hahnemann debacle than I ever was about my heart transplant, and they were by my side the whole time.

A lot of people (other than friends/fam) were by my side— from the Drexel faculty, the Hahnemann staff, and mostly all of my Twitter friends. <3 I appreciated that.

And I love chaos and I love the unknown and I love craziness. I am the definition of an adrenaline junkie. “Come at me bro” with everything.

But I just really hope the next few months are stable and normal for me.

No more sudden catastrophes, please.

To end this, here are some things that you may be interested in:

1) NEJM’s Dr. Lisa Rosenbaum interviewed me and a few others about the effect of Hahnemann’s closure - read it here.

2) I wrote this piece in JACC for all of you who work in healthcare. You work hard. Please read it. I mean every word. Thank you for all that you do.

3) Pics from Summer 2019 (between Philly & the H-Burg)

Hahnemann Part One

I was going to spend the rest of this blog talking about my Life After Transplant. I was going to talk about all of the crazy, sad, funny, and even some unfortunate things that happened to me after getting discharged in January 2019. My first everythings— my first acute rejection, the first “coffee date” I had with one of my favorite ER nurses, my first hair cut, the first time I got sick and was worried about having to get admitted to the Intensive Care Unit all over again. My first BBC interview. Wink.

I was going to start work on July 1, 2019. Part-time— administrative and teaching duties to begin with. I was going to spend the rest of my summer hanging out by the pool, blogging about my unforgettable firsts during my “discharged” days, and studying everything that I may have forgotten about Emergency Medicine. Hashtag post-transplant-life.

But instead, life handed me a new surprise.

Like, RANDOM SUDDEN HEART TRANSPLANT. Things looking good. And then. BAM! SUDDEN HISTORICALLY SIGNIFICANT HEALTHCARE CATASTROPHE AND UNEMPLOYMENT!

The week before I started working again, there had been rumors going around that my hospital (Drexel/Hahnemann University Hospital aka The Big H aka HUH) was going to shut down. Mind you, these rumors had been going around for years. Decades. Once in awhile, they’d resurface. We’d laugh. The hospital wouldn’t shut down. And we would continue with our jobs.

HUH was one of the oldest hospitals in the nation. Basically run like a county hospital— an inner-city tertiary care center catering to all different types of patients. We were always “doing more with less.” We didn’t always have the most innovative and sexiest medical technologies available. Our elevators didn’t always work. And yeah, our patients didn’t always have insurance, and in fact, many of them were homeless. But we loved taking care of them. We loved our jobs.

So...

July 1, 2019. I went back to work. The crazy transplanted ER doctor resident girl, basically on her deathbed just months ago, back at work. What a miracle, how beautiful, how courageous. Inspiring. Tupac & Oliver Sacks would’ve been proud. I was ready to conquer the world, and then as I walked into the hospital, I realized:

Shit. THIS HOSPITAL IS CLOSING?

News cameras everywhere. People crying. Everyone in disbelief. My phone going off by the second. The OB resident saying this, the Anesthesia resident saying that. The Internal Medicine resident continuously calling the Radiology resident, in turn continuously calling the Nephrology fellow… The Emergency Medicine residency group chat just ding-dinging with updates (or rumors, we weren’t quite sure).

From what we could gather, Joel Freedman, our hospital’s CEO, decided to shut down Hahnemann. He was losing $5 million a month. Allegedly. (We will never know what was really going on.)

Anyways.

Was he *expecting* to profit off of The Big H? Do not compute. What?

Oh wait, he was no doctor. He wasn’t even in healthcare. Silly me to keep forgetting that ... healthcare institutions... are… usually… run by... business people. Womp womp.

He purchased HUH exactly one year ago, stating that his company was going to help us out. Turn everything around. I mean, it SEEMED like he wasn’t in it for the money.

And then there he was, telling us that he was losing millions of dollars per month. Telling us that he was going to shut down the hospital. Boom.

He wasn’t noticing the 2000+ employees (nurses, doctors, techs, support staff included) losing their jobs.

It didn’t seem like he cared about all of the medical and nursing students who were using HUH as their first glance into the Real World of Medicine— an educational platform, where lectures were taught, where renowned Drexel University professors were attentively listened to.

He wasn’t acknowledging us residents, working 40-80 hours per week, after sacrificing our 20s to learn the intricacies of Medicine, using HUH as our training institution to further our careers. To take care of some of the sickest people who needed our help, no matter their gender, skin color, socioeconomic status.

Most importantly, though, he wasn’t seeing our patients. If only he saw what we handled and dealt with on a daily basis. How many lives we changed. How many souls we saved. How many people would come into our emergency department, afraid of being seen by our doctors because they didn’t have insurance but also really wanted to get a wound checked out. A safety net hospital. We also had patients who would come in regularly, for hemodialysis or chemotherapy. What were they going to do?

All right. We were going to close. That’ll take at least a year, I thought. Nothing is going to happen overnight. (Fast forward - it took just a couple of weeks). I called my parents. I called my cousin, a business lawyer. I called anybody I could think of— even my friend who once took a course in Contract Law. I remember that he said that it was the hardest class that he had ever taken. He might have been able to help me out here. Someone HAD to help me understand what was going on.

I remember some words like LLC, Chapter 11, Chapter 7, subpoena, deposition, corporate vs. civil, bankruptcy court ... and I remember them all being really confused about the situation but ultimately saying something like, “Yep. It is what it is. Welcome to America.”

And then I remembered myself in the hospital just a few months ago. People pestering me about how this could have all happened to poor me, and I remember basically always responding with,

“It is what it is. Let’s move on with the show.”

I took my little heart thing and tried to look at the bigger picture. Remember? I tried to make something of it. I tried to learn from it.

So I took a step back and tried to look at the bigger picture of our hospital closing. It is what it is.

This was disastrous. But this was something we could learn from.

What Joel Freedman and AAHS (his company) did was an absolute travesty. However, the system let it happen. What we had here was a failure of the system. HUH was a for-profit hospital. A company with a business-minded CEO was able to buy it and thus tried to profit off of it, as it would any other Macy’s or Dave & Buster’s (am I not right on this?). It ultimately did not profit off of this urban, inner-city healthcare institution that catered mostly to uninsured patients. So it filed for bankruptcy.

So there’s one system mistake: for-profit hospitals.

A lot of things were kept under wraps from us. Really. Nobody believes us when we say it, but we didn’t know much about what was going on. Doctors— attendings and residents— were not represented very well in all of this. Our nurses did a wonderful job of speaking up and making themselves heard (and we joined them many times during their rallies). The administration knew about what was going on most of the time. But I felt like us physicians were the last to know anything, and the least represented. The ACGME was able to help us residents towards the end of all of this. But our faculty had little say in anything and did not know what was going on most of the time. And they continued to work, and they continued to help us look for new residency spots, without knowing what was going on, without knowing if they were going to get a paycheck (or have a job) by the end of the week.

So there’s another system mistake: physician representation during hospital catastrophes. I’m a fairly new physician. A young and naive physician. I ask those who have been practicing for years (our mothers and fathers and mentors): are physicians even represented well … EVER? Are our voices ever heard?

Oh and, 500+ residency and fellowship slots were at stake during all of this. Our funding through CMS was at stake. There were rumors going around that, because the company had filed for bankruptcy, we would be “unfunded residents” looking for new hospitals to work at. This may be a bit confusing to understand (I don’t really understand it either), so please bear with me as I try to explain the process:

  • Residency slots are funded by CMS - Centers for Medicare & Medicaid Services.

  • CMS gives each hospital XXX dollars per resident that they hire.

  • Hospital takes a part of it, and resident gets a part of it as their annual salary.

We were supposed to be transferring to new hospitals to continue our training (another fiasco that will be talked about), but it would be helpful only if we transferred to that new hospital with our funding. There were rumors circulating for 3 weeks about whether or not our funding was going to “come with us” (because of the bankruptcy filing), putting us all through way too much stress. Was there one lump sum somewhere waiting for us? Did the company that owned the hospital even have this money or did they spend it on yacht parties? I don’t know what CEOs do, but I saw that Enron documentary once. And Fahmi Qadir taught me a thing or two about businesses.

System mistake #3: probably not a good idea to have residents who depend on CMS funding at for-profit hospitals.

(Another mistake: communication issues in general, we were getting our information about what was happening to us from WHYY and The Philadelphia Inquirer.)

The funding wasn’t the only issue with the residents. There were no guidelines set in place for 500+ trainee physicians to suddenly become “orphaned” (aka have no residency because of a hospital shutdown) in this fashion. Remember, this was SUDDEN. Specialties (like Orthopedic Surgery and General Surgery) that have specific rules in place to be able to sit for their board exams (e.g. their final two years of residency must be completed at the same institution) were scrambling to come up with solutions/exceptions because of this never-before-seen emergency. International Medical Graduates had their own set of problems to deal with regarding their J-1 Visas. And those doing extra Chief years in various specialties (like Internal Medicine) had no idea what they were going to do.

And yet another mistake: no guidelines in place for residency and fellowship program emergencies. I can’t blame ACGME or CMS or the People in Charge (and at this point, we are really confused as to who exactly is in charge), because this has never happened before. But perhaps we can use this experience to come up with some sort of emergency plan for the next set of residents this may happen to. And I have a feeling that if Wealthy Businesspeople in Suits see what happened with this for-profit hospital, and we don’t put an end to this quickly, this JUST MAY happen again.

Because let’s just face the reality of it all: condos in Center City, Philadelphia will make this company more money than Hahnemann ever did. And I believe that they knew this when they purchased the hospital in the first place. But hey, that’s just my opinion.

So, there are TONS of things we can learn from this. And I’m only talking about the system right now. Yeah, it’s totally “Alin” to look at the bright side of things. “Hey guys, at least everything sucked for only a few weeks but we are mostly OK now and we can learn from it all!” I know.

But, I keep telling people that dealing with all of this sucked, but in the weirdest way … it kind of brought me back to reality.

It’s kind of nice to be able to experience even the crappiest of experiences than to not experience anything at all.

As in, it’s kind of nice to be able to experience all of this than be dead. You know?

I know that it sounds cheesy, but it’s true. Through all of this, I have had a different perspective than most (again, I want to make sure people understand that I *do* think that this is all terrible, and in no way justifiable).

My first week back at the hospital was filled with people seeing me for the first time, not realizing who they were talking to, saying things like, “This is such a crappy situat—-ALINNNNNNN!!!!!!!!!!!!!!!!!!!!!! OH MY GOD! YOU’RE ALIVE!!!!!!!!” We’d cry and hug. And we’d get angry at the CEO together. And we’d laugh at how ironic my whole situation was all over again. The whole spectrum of human emotion, multiple times a day, every day that I was there.

And I would walk back home every single day thinking, “Wow, I can’t believe this hospital is shutting down, and I can’t believe my residency program is coming to an end, and I can’t believe I only had a few months left … And I can’t believe that I am so alive right now.”


So that’s just the beginning of what I had to deal with during the month of July. Part Two will be available soon, it’s kind of all still going on. But I figured— I keep getting asked about what happened so I thought I’d put “my side” of things out there for everyone to see for now.

What matters most is how well you walk through the fire.
— Charles Bukowski

Updates

Hi everyone!

It’s been a hectic two weeks, so I’ve put off updating the blog. I actually began working again last week, which was REALLY EXCITING … until I found out that our hospital is closing and I will need to transfer residency programs. Just when you thought things couldn’t get worse, we added another CRAZY chapter to my life.

I will get back to heart transplant updates and funny stories soon … once I get my life back together (for a second time this year, ha).

But I want to put this hospital closure out there because I want people to be aware of what happens when corporations try to profit off of hospitals. Our hospital, Hahnemann University Hospital, was bought by a company called AAHS last year. Suddenly, we were told that the hospital was losing money— the company couldn’t handle these losses. And then, just like that, we were told that our hospital is closing.

Our hospital (a tertiary care center in the heart of inner-city Philadelphia) caters to tens of thousands of (mostly underprivileged and uninsured) people per year— it’s a safety net hospital here. An asset to our community.

I am so sorry to all of our patients. But it was an honor to be your doctor for the 2.5 years that I worked there. You taught me so much, & you let me take care of you. Thank you.

Perhaps we can begin making some changes in health policy because of this catastrophe. Perhaps some good will come out of this. Right?

Read more here, or simply Google “Hahnemann closure” for more information.

Graduation

This week, I was supposed to be graduating from residency. I was supposed to be moving to New York City in two weeks. My bags would’ve been packed. Boxes around my apartment would have been half-filled with memories of these last three years in Philadelphia. 

I had a photo framed from the night before [us] interns started working in the ER. Beer bottles and wine glasses in hand. Sitting around a table at some beer garden. We had cheers’d to the next three years and all of the things that we were going to learn and experience. 

I had my journal— the one I left on my coffee table for three years. I made people write in it when they would come over. Usually, they were drunk. Always, they were happy. One of the best lines that someone wrote to me in July of 2016 - “Thank you for being a living, breathing, real-life example of how life is too short and you should live every day as if it were your last. I feel like I’ve lived more in the past 3 days than I have in this entire year.”

Proud of that cheesy one. ;)

I had my candle collection, my books, my old records (without a record player, from when I was in a strange ‘hipster’ phase). All of these things would’ve been in boxes. As far as residency goes, I would have been checked off on all of our appropriate emergency medicine procedures: lumbar punctures and central lines and chest tubes. I would have finished answering some of my board review questions. I would have been getting a certificate of completion, a paper showing that I was, indeed, ready to become an ER attending physician. I would have gone out afterwards with all of my co-residents, and we would have cheers’d to the next chapter of our lives. One last “Cheers!!!”

But the things that were supposed to happen just didn’t end up happening. And here I am today, getting ready to take my nighttime medications before checking my blood pressure, my temperature, my blood sugar. Enalapril, amlodipine, tacrolimus, mycophenolate. My nightly protein shake is ready on the kitchen counter. Ugh, routine. I have a migraine headache, and it’s making me feel like I need to go to sleep early tonight. 

Of course I think about what could’ve, should’ve happened. I could have been graduating. I should have gone to the doctor earlier. And of course, there are the days where I’m angry or sad or just a little bit jealous of others my age … just casually living their best lives. They get to go to the movies without wearing masks. They don’t have to worry about death by food poisoning. And they get to drink all of the RedBull and all of the vodkas (and all of the RedBull-vodkas) that they want to.

But thinking so much about the past will never help me move on. And sometimes, I laugh about all of this. It makes me feel better. Life is funny— it shouldn’t be taken so seriously. 

Most of the time, I’m comfortable with my situation and where it has gotten me, what it has taught me. Not many get to experience this crazy but incredible thing that has changed my life forever. And so much good has truly come out of it. I’ve met so many good people (who have gone on to become some of my CLOSEST friends - Chip, this is for you), and I’ve helped a few others (or so they say). And also, I’m just a badass for handling all of it. I mean, who even goes to work a short few months after dying?

I forgot to mention … This scar on my chest is a great conversation-starter. And, as it turns out, I’m a great storyteller. Ask me about my scar, I’ll give you the craziest story that you’re ever going to hear in your life. You’re going to tell me that I should write a book about it. I’m going to give you the URL to my “Instafamous” blog.

But would I rather have just been graduating today? 

I don’t know.

To end this one, here are some of the MILLION photos I have on my phone over the last three years of residency, PRE-transplant ;)

Updates

Hi all!

I know, I’ve been the WORST with updating my blog. I found out that I’ll be starting work soon, so I’ve been busy with getting excited for that. ;)

If you aren’t sick of my story yet, I wrote an article for EMNews … you can read it here.

Also … The Philadelphia Inquirer recently did an interview with UPenn social workers, my friend Caitlyn, and me. In this piece, we talk about the importance of mental health before, during, and after transplant. People keep saying that I’ve had a good outlook on it all, and that I’ve been [ridiculously] positive. I do think that when life throws something [ridiculously] crazy at you, you only then realize how strong you truly are to overcome it; your mindset matters. Thanks to therapy, introspection, mindfulness, understanding the importance of emotional health, and (oh yeah) maybe my Bachelor’s degree in Psychobiology … I am where I am today.

And lastly, one of my blogposts about my feelings toward my own mortality was published in The DO. You can read it here (or just scroll down ;) lol).

I will soon start blogging about my life after transplant and how hilarious, heartwarming, difficult (but do-able) this all has been. Can’t wait.

Thanks for all of your support, everyone. Can’t believe it’s been almost five months!

P.S. I was thinking about this recently .. it’s been very hard trying to go “back to normal” (see pics below) but I take baby steps every day. Sometimes, I’m scared to go somewhere because it’s too crowded or I’m anxious about the food that I’ll be eating (remember, I have to be careful for awhile since I am so sensitive to infections).

But I decided this: I can’t focus the rest of my life on “not dying.” I must instead focus on “living.” Cheers!

The Letter

I recently received a letter from my organ donor’s family. I have been very vague about the contents of the letter to respect them and their wishes (and please do not ask me to send it to you). What I have not been (or will not be) vague about are my feelings about reading it, processing it, and continuing my life knowing who’s heart is beating inside of me. 

My organ donor was a young girl who was, also, in the prime of her life. She was in school and was involved with many extracurriculars. She seemed very loving, and was absolutely admired by all around her. She was passionate and had many big goals that she never got around to accomplishing.

But her loving, caring heart lives on inside of me. 

Some have asked how I felt when I read it? Reading the letter was difficult and emotional because I really found out about the girl who died and gave me her heart. She was another human living her precious life on Earth, just like me. She was a beautiful soul.

I realized that the day I celebrated the most (and have been celebrating) was the day that I was reborn with a new heart— during the early morning hours on that cold, January day. But now, I will remember that this day marked the end of her life. She will forever be a big part of me (both literally and figuratively). So do I celebrate life? Or do I mourn death? 

The obvious answer is that I should celebrate life. Her legacy will live on. I can do so much with our heart. I can go back to saving lives. She will go back to saving lives. I get it. I absolutely do. Really. I understand the positive things about this.

But I am only human. The darker thoughts will always linger. 

I am so grateful that someone young with a healthy, strong heart died as an honorable organ donor— I needed that heart quickly. But I am so upset that someone young with a healthy, strong heart died. I am so happy that I get to live the rest of my life to accomplish all of my goals. I am so sad that someone else will not be able to accomplish her own goals because of a sudden tragedy. I am so excited to spend my time with my friends and family during this (awful) medical leave. I am so angry that her friends and family can’t spend time with her, unless you count the moments they stand around her gravesite— being six feet under is just not the same.

I am so lucky to be freely breathing this fresh air with no cough and without any lifesaving pressors and inotropes— remember, I can conquer the world nowadays. 

I am feeling so guilty, though. These were supposed to be her breaths. 

It’s interesting to think about. Truly. We were both in Intensive Care Units, miles apart, at the same time. We both probably had the same procedures done to us— was her central line on the right or left side of her neck? Was she on propofol and fentanyl? Surely she was on her own life-saving medications, I wonder which ones. Did her arterial line continuously kink and need to be replaced? 

I imagine that her family was there, too, hoping that she would get better. I wonder how many balloons and gifts were neatly laid out around her bed. I wonder if her friends were there, trying to make her laugh with stupid jokes. I wonder how many times they held her hand. The words haunt me now …. “Can you squeeze my finger?” She wasn’t able to. 

Sigh.

On the same day, two incredible things happened: 

In an ICU, I was told that I was going to be able to live my life again. A glorious moment. My physicians and nurses came in to hug me. 

My family and friends were in and outside of my room. Everybody was hugging and crying. 

But a physician in an ICU, miles away, told a family that there was little hope left. She listened to the last of her lung sounds, her heart sounds. She checked her pupils, both dilated. A quick "Time of Death" was recorded in the chart.

Her family and friends were in and outside of her room. Everybody was hugging and crying. 

So similar, yet so different...

I guess Kurt Vonnegut put it so nicely once:

”And so it goes.”

I will write the rest of this post (selfishly) for my own peace of mind. Perhaps her family will read it someday:

My Kyank, 

Kyank is the literal Armenian word for “life,” but it is used to address the very special people in your own life (the ones you love more than anything). It’s only fitting that I call you that.

I am you, and you are me.

I had a lot in common with you. It was more than just our blood type and body habitus. In fact, it was kind of chilling to read about your interests. We probably would have been good friends. But instead, our paths crossed in the strangest of ways. On the last day of your life, on the first day of my life. On the worst day of your life, on the best day of my life.

And I will be honest— I don’t know if I should be upset or happy or angry or guilty or grateful about that. I just don’t know. 

What I do know is what I've been saying since I woke up with your heart inside of me: I will do everything that I can to honor you and your family. 

Thank you for the gift of life.

I love you. 

-A

Pre-Op & Post-Op

They began wheeling me to the OR right around 2am. My mom and my cousin were walking down with us. My dad was on a flight back to Philadelphia. Everybody had been notified of the news. I was ready. I think.

My mom kissed my forehead. We all hugged. And then I blurted out the million dollar question, “Mom, what if I die?” 

And then she replied with the same thing that she had been saying for weeks. 

“If you had to die, you would have died already. You tried dying so many times already and you didn’t. You have a lot of things left to do in this world. You aren’t going to die.”

I’m not particularly spiritual, but in that moment, it was such a perfect thing to hear. Moms really are the best. 

The OR was so bright. I hadn’t been in one of these rooms since my General Surgery rotation in medical school. And this one was top-notch. Huge. Probably the size of my whole apartment. There were at least two large HD screens staring at me. Everything was white, blue, sterile. Cold. Fascinating. I saw a generic OR checklist up on a screen, and my name was written somewhere already.

The technicians were getting some things together. The nurses began asking me some basic questions about my birth date, my allergies, etc. I don’t know if it was because my voice cracked, or because I was unusually quiet, but I think everyone around me knew how nervous I really was.

They tried to make me laugh by saying things like, “You’re gonna be famous after this, girl.”

I reacted with sarcasm, of course. I think I asked them to try not to kill me. 

“We know what we’re doing. This isn’t our first rodeo,” they replied. We laughed some more. 

The attending Anesthesiologist came in to help with the placement of my (millionth) arterial line. 

“You know, these don’t hurt as much as I thought they would. I don’t feel a thing. I actually feel great,” I told him.

“That’s because of the Versed we just gave you.”

I chuckled.

“You ready? We gotta get you back to saving lives,” someone else said. I smiled. Yeah, I guess I did have to go back to saving lives. That made me feel better. Just a little tiny hurdle, a speedbump if anything. You’re going back to work in a few months. This is nothing.

There were a few people coming in and out of the room— making me smile, shaking my hand, giving me high fives. The CT Surgery fellow came in and asked if I had any last minute questions.

“Can you get rid of my uterus while you’re in there? Just take that thing OUT!” I asked him.

“We really only deal with the chest … but we’ll see what we can do,” he replied, with a smile.

Someone asked me what kind of music I wanted to listen to.

There was no question about it. The man who had gotten me through all of my life’s struggles. Always do your best, don't let the pressure make you panic and when you get straaaanded and things don't go the way you plaaaanned it…

“Tupac.”

And then they actually put on Tupac radio! I felt at ease. I felt good (again, might have been the Versed…). 

I heard one of the nurses say that the “heart was good to go” (I didn’t know this, but apparently the surgeons have to do one last visual check on the donated organ after it has been procured and tested extensively). They had just finished examining it, and the attending was preparing to start the surgery. “They'll all be in here soon, okay? We’re gonna finish getting you ready.”

The attending and the fellow are probably changing into their scrubs, tying their caps. They're in the locker room, probably talking about how the Sixers have been doing. There’s a medical student reviewing the nerves and vessels around the heart; she knows that she'll be pimped on them. She’s nervous because this is her first open-heart case. There’s a resident running towards the OR while inhaling a protein shake because he hasn’t eaten anything in several hours. My case woke him up from sleep. I’m sorry about that; I know how much you hate cases in the middle of the night.

Alin, this is nothing for them. It’s second nature. One beautiful incision after the other. Their well-trained, delicate hands know the ins and outs of open-heart surgery. They check off each action, one by one, in their brilliant minds. Cut here. Snip there. Be careful of the recurrent laryngeal. Remove heart.

Take my heart out. 

No. You know what? Violently rip my heart out of its cage! Get rid of it. This stupid heart that put me here in the first place. I was proud of you at first for living so long, but now I’m angry with you for dying so early. My life had been going so well. So well. I had worked so hard. I rarely complained. I was a good person for the most part. I did nothing to deserve this. Here I am now, all alone on this cold metal slab, just patiently waiting for the most frightening moment of my life. You’re barely working. You’ve decided to be difficult. You’ve made everybody put their lives aside to worry about me. I hope you’re happy.

I had a love-hate relationship with my old heart, but I spoke to it often. I was very open with it. (And, in case you’re wondering, I can say the same thing about most of my human relationships. Sigh.)

I felt it, though-- I was getting more anxious. Angry. Sad. Self-pity at its finest.

“Can I just talk to my mom one more time?"

“Absolutely. Here, call her,” said my nurse. She handed me a phone.

I called my mom and I told her that they were about to start. People were setting up around me. There was music playing. Things were getting blurry. I think the medications were kicking in because I started tearing up. I felt really warm.

“Mom, I’m not going to die during surgery, right?”

“You’re not. What do I keep telling you!"

“But remember, this is risky open-heart surgery.”

“But remember, you have so much left to do in this world."

I remember nothing else, other than a very distinct and overwhelming feeling of peacefulness (but again, that might have been the Versed…).

I understand the basics of Critical Care Medicine. I read the literature when I can. I know that less sedation and early mobility have the best outcomes for our intubated patients. Blah blah blah. 

“Can we just decrease their sedation? See how they do? Let’s get them off the vent by tomorrow?” I recalled asking an ICU nurse many-a-times in my career. 

Oh but I am so sorry for all of the times that I’ve done that. So, so sorry. I want my patients to do well, but I never knew how uncomfortable that breathing tube was. I would be called to go back into their hospital rooms because they were becoming agitated. “SIR, I KNOW ITS UNCOMFORTABLE! BUT JUST WAIT A FEW MINUTES! PLEASE!”

But no. No no. I didn’t know how uncomfortable it was. Now I do.

Here we were again. Me vs. The Vent. I gagged on my own secretions, and tried to grab the Yankauer suction handle. F&#%! I’m in restraints again!!! I think I was trying to scream. There were a few people around me. My nurse walked in, surprised. “It’s okay! We’ll see if we can get that out soon? I’ll be back.”

A respiratory technician came in and I kept pointing to the tube in my mouth. I started crying. Pure agony, I promise. Please someone help me, I just want this thing out.

My nurse came back in with some paper and a pen. 

Any complications?

Increase fentanyl or propofol?

Increase propofol?

EXTUBATE?

I felt like nobody was listening to me. Or reading me, or whatever. And then the attending walked in. “Hey Alin, I’ll be the attending doc for the night, okay? So we were going to extubate you in the morning, but if you're comfortable with it, we will do an SBT, get another gas, and go from there.” 

Oh, cool. He knew that I was a doctor. I liked that doctor talk. I gave him my restrained thumbs up, miserably losing my battle with The Vent in tears, while coughing up all sorts of secretions. My lips were dry and bleeding. There was sputum just slowly dripping down my chin and onto my gown. It was probably the most pathetic moment of my life. Those poor restrained thumbs up…..

(I laugh about it when I look back. Why? I came to find out later that the intensivist on call during those nights was someone who I had looked up to for years— one of the reasons why I was even going to do an ICU fellowship. I knew about his work since medical school, and wanted to be just like him “when I grew up.” Funny, right? So imagine drooling in front of your role model— just a humble, world-renowned ED/Critical Care physician, no big deal— who you’ve been excited to meet for years. Yep.)

He said that he’d be back in a few minutes, and the respiratory technician came back in. 

“We are just waiting on the blood gas results, okay, dear? I know it’s uncomfortable. I’m so sorry. Just a few more minutes.” 

I tried to glance at my ventilator settings. I passed the SBT. Please. WHAT DO YOU NEED AN ABG FOR!

Honestly, I don’t even think that I realized that I had just had heart transplant surgery. I couldn’t think of anything except getting that tube out.

The respiratory tech started setting up another oxygen machine (something we do when we extubate people instead of letting them breathe on room air right afterwards). And then, she pulled out the tube. And I took my first breath as Post-Transplant Alin. 

I felt wonderful.

I was so excited. My family was standing around me. They were clapping. I tried to feel for my own radial pulse. Top-notch! Bounding. Surreal. Beautiful.

I took a look at all of the new fun medications that I was on. 

Insulin drip? What the hell? Why do I have these wires coming out? What even is THAT wire? Do I have TWO central lines? What does that machine do? Is this a pacemaker? Why do I have a pacemaker? 

I lifted up my gown (I had no shame, ever). Woah, look at all of these surgical chest tubes! I looked at Matt and pointed to the chamber. I wanted to see how much I was draining. 

I was The Quintessential ICU Patient. Post-Op. In the CTICU. Lines, tubes, and wires everywhere. Dressings on top of dressings covering I-don’t-even-know-whats. My hair was a complete mess. My whole body was orange (from prepping me for surgery). I looked like a puffy, orange (but smiling) blowfish with wires coming out of every orifice. A child’s 5th grade science project.

Or, as my best friend (who is not in medicine), put so eloquently: “You look like an outlet.”

I guess most people wouldn’t be that excited, but when you’re almost an intensivist-in-training and also critically ill in the ICU, you may just look at these things in a different light.

And I guess that was the lesson of the day, confirmed over and over again throughout my struggles earlier this year. Your psyche, your perspective really do go far when it comes to life’s hardships. 

What do I mean?

Thanks to my mom, I calmed down about the surgery. She helped me realize that I was strong. It became nothing that I couldn’t handle. 

While I was in the OR, I was surrounded by lovely people who reminded me that they do this all of the time. I talked myself into the fact that it wasn’t a big deal— I literally knew what they were going to be doing. It became no big deal. 

After the surgery, I didn’t see my lines and tubes as painful torture devices that were there to just irritate me or perhaps leave awful scars. Instead, I saw them as incredible pieces of medical technology, each playing a major role in my healing (and some even keeping me alive). They reminded me of the reason why I had gone into medicine in the first place— why I was especially fascinated with Emergency Medicine & Critical Care: to help the sickest patients who needed the most support. I wanted to make sure that our fierce, determined attitudes and excellent resuscitation skills helped save not only their lives, but their souls. I wanted to remind them that there is so much hope and potential left, even after dancing with death and slowly sinking into the worst moments of their lives.

Sure, I was in pain, but I was lucky. It was such a humbling moment. The most humbling moment of my life.

And here is where I’ll say it: It was an honor to be in my patients’ shoes.

I’d be able to laugh and cry with them. I’d be able to physically feel their pain, their anxieties. I’d be able to read their minds— all of their thoughts about death and if their lives had any meaning at all, if they had truly lived it well. I’d know that their dignity meant everything to them. I’d know that their insomnia only came from every single one of their life’s regrets just being replayed over and over again in their heads during those nights. Every single one.

I would say things like, “MRS. SMITH, I KNOW ITS TOUGH!”...

... and I would really know how tough it was. 

How phenomenal was that? 

What an honor it truly was...

How interesting life is... 

But hey, that’s just how I saw it. 

Sorry I yelled at you earlier, Old Heart. I guess that you taught me a lot over the last few weeks.

To end this post, just remember …

…. keep ya head up.

The Call

Going back to my hospitalization…

I always had many people around me, especially in the evenings. On this particular day, I had two of my friends visiting me. My family had decided to go out for the night after I pushed them into doing so. “Please go. Have fun. FOR me,” I told them. 

Where did they decide to go? A nearby casino. My family really is amazing. 

My friends were sitting next to me— I was particularly close with them and was very excited to have them there that evening. We chatted for a while. I told them the story about how I accidentally snapped at the CT surgeon earlier in the day, because I mistook him for Matt. We talked about the overly zealous guy from dietary services, who was so keen on always getting my order right. I told them that I had argued with the Cardiology fellow and Anesthesiologist about keeping me NPO for a procedure—“It’s not like I ask my dying patients what time they’ve eaten before I emergently intubate them!” Right? (I mean, I’m right.)

After a while, they let me unleash my anger.

Every day, I would have to explain to people that I didn’t care if the food wasn’t the best. I didn’t care if the sun wasn’t shining into my room that day. I didn’t even care about my gown being too big on me. Thank you for reminding me how shitty my situation was (even shittier than I thought) by bringing up all of those shitty little things that I wasn’t even worried about in the first place.

I barely had an appetite, so when I did, I was happy to eat. And you know what else? My hospital wasn’t a restaurant. My hospital was a world-renowned academic institution with some of the most brilliant doctors and nurses that I had ever met. I actually didn’t want my hospital to be a restaurant.

Honestly, though, I was lucky to even be alive to have the option of eating. Even syrup-less pancakes with apple juice were delicious when you were constantly being reminded that you might die that day.

Sure, the sun wasn’t shining into my room and my view wasn’t the best, but when was a hospital room supposed to be a hotel room? Plus, I preferred this sub-par hospital room over a shelf in the morgue. I assure you.

And ah, my favorite complaint: my gown didn’t fit me. What did people want me to do about that? Every time my visitors were dramatically worrying about my gown size, I remembered that old Brian Regan bit. Brian's optometrist once confronted him about his lazy eye, and followed it with, “It’s no big deal. It doesn’t affect your vision or anything. I just thought you’d like to be self conscious for the rest of your life.” Ha.

So others complained for me most of the time, while I just laid there and wondered when they were going to stop being so pretentious and ignorant. When were they going to start worrying about the things that they really needed to worry about? Sometimes, I wondered how they would feel if they were in my place. There is no way that they’d be complaining about the cafeteria food if they were on their deathbed.

Maybe.

I don’t know.

People are strange.

I had always hated perpetual complainers, but throughout this hospitalization, I came to the conclusion that I never wanted a toxic complainer in my life ever again. I remember reading something like, “You have to die once to really learn how to live.” Take that piece of truth to your heart. Swallow it whole. Remember that constantly complaining isn’t going to change anything. Life is so incredible and has the potential to be lived so well. Some definitely need to realize this more than others.

Anyways, back to my story.

It was a good visit with my friends. After the visit, I was basically alone in my hospital room— a rare occasion for me in the evenings. I was feeling very tired that day. I didn’t really know what I wanted to do before going to bed, so I was just staring at the walls. I looked over at my monitor. I glanced at the medications I was on. For once, I decided to turn the TV off (if you know me, you know that I cannot live without background noise— the noisier the better).

And I just sat there. 

I then remember my nurse coming in with a phone and telling me that I had a call. He handed me a phone and left the room. 

“Hello?”

The only thing I remember from the phone call was:

“Blah blah blah blah MATCH blah blah blah HEART blah blah ACCEPT?”

“Yes. I have to go call my mom now.”

And that was the best I could do. I have to go call my mommy now. No “thank you,” no “OH MY GOSHHH!” There were no balloons. There was no party. There was no clown, no party favors, no crowd. My residents and nurses weren’t throwing confetti into my room, either.

I was just comfortably alone. During the happiest moment of my life. I felt pure bliss.

And then, I felt nauseated.

And then, I vomited.

(Just like I always did, since I was a child, when I was nervous about something. Physical manifestations of how I was feeling psychologically, I think.)

I called my nurse and asked for some Zofran and mouthwash. 

“There’s a heart!” I told him. He was very excited too, and he told me that he’d come back in a few minutes with a plan. 

I had promised my family and closest friends that I would call them the moment I knew that I had a match. But (please don’t hate me), in that moment, I just wanted to sit with myself. It was a quiet 10 minutes. I did some reflecting.

I thought about who my donor could be. Maybe a 20-year-old female involved in an MVC. Perhaps a 26-year-old male who was braindead after a sudden illness. Maybe my donor was that other 30-year-old female who deteriorated after losing a battle with some random genetic condition that she didn’t know she had. 

Did my colleagues try to resuscitate this person? Could I have ever potentially resuscitated this person?

Moment of silence. I thanked my donor and their family.

I wrote in my journal, “Thanks for 30 years of service, Heart.” Super cheesy, I know, but I didn’t want to forget how I was feeling in that moment. Grateful that my poor heart had come such a long way with me. Thirty years of craziness.

I found myself smiling. I was going to live. The rest of this was going to be easy. They were going to crack my chest open, take my heart out, put a new one in, put a few vessels together. It wasn’t an extremely complicated surgery (from what I remembered during medical school). I would wake up afterwards. Probably with some pain. I would get discharged in a few days. I would go back to my normal life. Kind of.

I guess one of the hardest thoughts that I ever had (and continue to have) was this: things were never going to be normal normal.

But I would get as close to that as possible. 

This was nothing that I couldn’t handle. I had gotten through Organic Chemistry at UCLA. I used to work full-time night shifts while attending an accelerated Master’s degree program in the mornings. I had moved from Los Angeles, CA (population: 10 million) to Cumberland Gap, TN (population: 500) all on my own, without knowing one person, and had beautifully made it through medical school there.

I had once battled a complicated case of appendicitis (not surprisingly, I had been very stubborn about going to the ER then, too) and I had been able to make it out alive. I had actually showed up to Anatomy Lab just three days post-op (I was kicked out by my professor, though … “You need to go home and rest!”)

This was just a minor little speed bump in my life.

My friends would repeatedly remind me that I hated anything that came too easy— we’d joke about how this would happen to me just because I loved challenges. 

Everything was going to be okay.

In that moment, I also decided that after I woke up from the procedure, I was going to do *something* with my life. Something special to honor my donor for the rest of my life. It would be something to make that family proud. I didn’t know what, but I knew that I would. 

With this inconvenient life event, I would grow. I would learn from it and I would use it, ultimately, to change the lives of a few other people (or perhaps the world, ha).

“Your character is built on how you handle moments of adversity,” I read somewhere. 

I think I was handling it well.

After my contemplations, I called my mom and asked her to kindly step away from the slot machines and return to the hospital (that part of my story always makes me laugh). I then proceeded to call the rest of my family and closest friends. I sent a message to my residency Groupchat. I texted some of my attendings. 

My nurse brought in some Zofran, some mouthwash, and chlorhexidine for my final ICU basin bath. OR Start Time was scheduled for 2am. Eventually, my family and friends came running into my room. The night float residents and interns barged in to give me hugs. Even the Pulm/Crit fellow (who had been consulted a week ago) came by before leaving the hospital. “I just wanted to say congrats. We were all rooting for you in the MICU. Thank you for being you.”

The Anesthesia resident came in with some paperwork and a hug. A few of my former nurses surprised me with “Congratulations!” and tears of joy. The CT Surgery fellow walked in, excitedly. “I’m so happy for you! Let’s do this!” he said.

“Yeah, okay! But who’s gonna be cracking my chest open in 6 hours?” I asked him.

“I probably will,” he said.

“That’s f&*%ing awesome. And don’t worry about the scars. I’m not one of ‘those’ patients.” I told him.

“You’re not like most patients, Alin.”

We all laughed.

“Oh yeah, speaking of, I’m apparently really difficult to sedate.” I told the Anesthesiologist.

“Yeah, that’s not surprising, but we’ll take care of that.” We all laughed some more.

I was so happy. I’m telling you— pure bliss.

I knew that everything was going to be okay. Life was going to be different, but everything was going to be okay.

To end this post, here are some memories from the day that I got The Call:

Updates

Just an FYI:

In case you don’t follow me on Social Media (which you definitely should!) — I am on a very mini hiatus from uploading new blogposts. I have been working on a couple of other things that have deadlines coming up (including writing a piece for a journal, which I’m so excited about).

I recently was interviewed for a few podcasts, which you can find here:

  • “MedInspired” Interview here

  • “Explore The Space” Interview here

I also want to thank my co-residents and friends for going to the Donor Dash for me this morning. I wasn’t able to go, but hopefully I’ll be able to go and kick ass during next year’s Dash!

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Prognostic Indicators

"What’s your prognosis?”

I get asked this all of the time. When did this become socially acceptable? Lucky for you, I’m an open book with a loud mouth. I'm inquisitive. And I have been trained to think scientifically.

I can go through many different percentages for you. According to a paper published by Dr. Anyanwu in 2003, 20% of heart recipients die within a year of the transplant operation. Afterwards, the death rate is 4% per year for the next 18 years, so that 50% of patients can expect to be alive after 10 years and 15% after 20 years. 

Or I can take a stroll through downtown Philly (with my Nikon in hand), while taking photographs of the skyscrapers that overlook the city that I’ve called home for the last three years. During this stroll, there is a small chance that I will get hit by a car. According to national statistics, there is a 1 in 572 chance that I will die after getting hit by that particular car. It will likely be from blunt force trauma. I will hemorrhage internally, and die a fast or slow death (depending on which organ has been lacerated).

I can carefully search the internet for the descriptive statistics regarding heart transplants— the medians, the maximums, the minimums, the averages of life expectancy. I can educate myself about our mortality rates. My own mortality rate. According to UpToDate, the median survival for heart transplants between 1982 and 2015 was 11 years for adult recipients. Many adult patients die about a decade after transplant. Younger patients usually live longer than that. I can anxiously look up the definition of “young” in two separate peer-reviewed articles. 

Or I can take the time to tackle my next feat. I have always wanted to get my pilot’s license. I was going to do it at some point after my medical training was complete. So, I can sign up for a course and start flying through the horizon, checking off another one of my life’s ambitions. But did you know that there is a chance that I will die while conquering this goal? According to Statistica, 561 people died in air crashes around the world last year. So my plane may crash from some sort of incorrect measurement, perhaps the plane’s fuel will be miscalculated. Most likely (55% of the time), it will be from pilot error— my own ignorance. I will die from penetrating trauma or pressure-related injuries, and my body will burn, slowly, into charred nothingness. 

I can rummage through my desk and find my ripped-up medical textbooks. Or my old notes and Powerpoint presentations from medical school. I can look through the high yield facts that we quickly glanced over about heart transplant patients and their medical histories, the few scribbles I had written down about their terrifying complications. I can remind myself that many heart transplant patients die a slow, painful death after being diagnosed with metastatic cancer. Usually by lymphoma, squamous cell carcinoma, or basal cell carcinoma.

Or I can take the next train to New York City. Or Baltimore. Wherever I feel like going. I can drag someone with me, or I can go alone. But this comes with a potentially fatal risk. According to the US Department of Transportation, there are about 5,800 train-car crashes each year in the US. These cause 600 deaths and injure about 2,300 people in total. So, there is a chance that I will die on the train after an awful collision with a car that just didn’t see us coming. It will be an instantaneous death, after a handrail gets jammed into my chest causing a bleeding gash right through my heart. My cardiovascular system will come to a sudden stop. And then I will die. 

I can ask my doctor about my future co-morbidities. Academic discussions, or as I like to call them, “doctors doctoring doctors." By the sixth year after transplantation, most heart transplant patients will have hyperlipidemia, or high cholesterol levels. About a third will have a rise in their creatinine levels, aka failing kidneys. A third will suffer from coronary artery disease. A fifth will have experienced some sort of cancer. 

Or I can call my parents. I can talk to them to pass the minutes this evening, because I just can’t seem to fall asleep. I can listen to their voices telling me to make sure that I eat, make sure that I stay warm. There is a chance that an unknown someone will then barge into my apartment. I will tell my parents to hold on, and I will open my bedroom door to find a person burglarizing my home. That person will then kill me, most likely with a gun. A gun shot wound to the head, or maybe (more likely) a gunshot wound to the chest. According to 2014 national databases, there are 15.9/100,000 random homicides yearly in Philadelphia, one of the most dangerous cities in America. So I will become a fatal statistic. Random home invasion, random homicide. Cause of death: (most likely) gunshot wound to the chest.

I can Google the longest someone has lived with a heart transplant for. 33 years. That can’t be right. I can Google it again. 33 years????? Perturbed, I can then think about how I won’t even make it to 65. Holy s&%#.

Or I can listen to Tribe’s Beats, Rhymes, and Life in my apartment (on volume 11). I can decide to invite a few people over for a game of Cards Against Humanity. Maybe I can have a beer with them, too. But, damnit— alcohol intoxication can also kill. According to the CDC, about 6 people die of alcohol intoxication every day in the US. So there is a chance that I will die from one too many beers that interacted poorly with my transplant medications. And it won’t be pretty, either. Altered mental status, hypothermia, respiratory depression, cardiac arrest, death. 

I can look up the fancy prognostic indicators— the things that put me at risk for early death. They say that prognosis depends on things like ischemia time of the heart (174 minutes). It also depends on how old you were at the age that you were transplanted (30 years, 49 weeks old) and how young the donor was at the time of death (unsure).

Or I can go for a jog, feeling the early spring wind against my face. Feeling every muscle in my body slowly get stronger after months of being deconditioned— I can take the pain. My determination and my willpower speak for themselves during these moments. However, there is a chance that I will suddenly die during this invincible jog. In medicine, we call it sudden cardiac death. I will begin experiencing an arrhythmia that my transplanted heart was statistically more prone to than a healthy native heart was. I will clench my chest, fall over, and die. Someone will find me in a few minutes. They will try to save me. But, according to national prehospital data, I will likely be dead upon arrival to the emergency department. 

I can spend hours upon hours meticulously punching in the numbers, searching the resources in our medical libraries, asking the cardiologists and the epidemiologists— what exactly is my prognosis? 

Or I can take the time to breathe. To live. To laugh. To cry. To love.

To write my thoughts out and think about the beauty of life, the irony and the mystery of this thing that I’ve been given (twice actually, technically).

To smile.

To be grateful. To be happy. To be angry.

To feel.

To remember that, for all of us-- not just for me-- life is finite. 

The scientific values and prognostic indicators and the medians and means and the what-if's and why-not's don’t change this one thing that we all have to remind ourselves (unfortunately) more often than we should:

that, ultimately,

life

is

finite. 

Until next time, from William Saroyan’s The Time of Your Life:

“In the time of your life, live—so that in that good time there shall be no ugliness or death for yourself or for any life your life touches. Seek goodness everywhere, and when it is found, bring it out of its hiding place and let it be free and unashamed.

Place in matter and in flesh the least of the values, for these are the things that hold death and must pass away. Discover in all things that which shines and is beyond corruption. Encourage virtue in whatever heart it may have been driven into secrecy and sorrow by the shame and terror of the world. Ignore the obvious, for it is unworthy of the clear eye and the kindly heart.

Be the inferior of no man, or of any men be superior. Remember that every man is a variation of yourself. No man's guilt is not yours, nor is any man's innocence a thing apart. Despise evil and ungodliness, but not men of ungodliness or evil. These, understand. Have no shame in being kindly and gentle but if the time comes in the time of your life to kill, kill and have no regret.

In the time of your life, live—so that in that wondrous time you shall not add to the misery and sorrow of the world, but shall smile to the infinite delight and mystery of it.” 

One Thousand Visitors

“MOM THERE ARE LIKE A HUNDRED PEOPLE AT MY APARTMENT RIGHT NOW, CAN’T TALK!”

“LIKE THIRTY OF US ARE GOING TO THE BASKETBALL GAME ITS GONNA BE SO FUN.”

“I WANT TO INVITE A THOUSAND PEOPLE TO MY GRADUATION PARTY!"

For years, my parents would say things like, “Alin, you can’t possibly even KNOW a thousand people! You exaggerate so much.”  I proved them wrong while I was hospitalized.

I had a lot of visitors when I was hospitalized. A lot.

My program director would come by multiple times a week with candy and gifts. He’d be patient with my parents, who would ask him both medical questions and questions about what was going to happen with residency. I’d wake up after long naps to other ER attendings in my room, just sitting there with my parents— sometimes crying, sometimes laughing, but always there for me.

“I can still be an ER doctor, right?” 

My attendings would reply, “Absolutely."

One of my ICU attendings would come by on her days off with People and In Touch magazines. “This will help you get your mind off of all of this.” She would take the time to ask me how I was *really* doing. “I feel fine! I really do!” And then she would stare at me until I said what I *really* wanted to say.

“Chest tubes hurt so much more than I ever thought they would,” I’d admit while looking away.

Priya, my favorite surgical resident, would come by with a bag full of anything she found at CVS Pharmacy on her way home from work every night. She’d be tired as hell after doing a liver resection or a laparotomy for hours. “Today, I got you a neck massager and these scrunchies." She’d lay in bed with me. I would have to force her off because the bed weight alarm would sometimes start beeping. “I don’t care,” she’d say. 

Every day, Matt would sneak in muffins and watermelon juice, sit down next to me, and work on his fellowship research with his laptop. Every day, I would tell him that I felt like a burden, that he should go back to fixing ACLs. Every day, he’d tell me to shut up. “You need to stop pushing people away. We all care about you a lot.” I’d roll my eyes and take a sip of my juice.

One of my attendings, known for his stoic demeanor and strict ways, once surprised us all by walking into my room. He stayed and chatted for a long time, in complete shock about my whole situation. When he was leaving, he almost made it to the door before he turned around and looked at me. “Alin, I want to tell you one thing. You have been so strong throughout all of this, it’s been unbelievable … and I just want to say that I would expect absolutely nothing less from one of the best residents I’ve worked with.” 

The whole room teared up. But I held my tears back. Instead, I said something along the lines of, “You’re just saying that because I’m dying!” 

He shook his head. He walked back to my bed to give me a hug. “You can’t die. We have to clear the waiting room on every shift when you’re back.” 

I teared up.

One of my close friends would always bring me breakfast bagels after being on 24-hour-call at the hospital. We had a rule: to not talk about my illness, and to treat me like he would on any other normal day. “When are you coming back to work to admit patients that probably don’t need to be admitted, you dork?” he’d ask. We’d laugh. We’d hug. I appreciated that.

My best friend from medical school flew in from sunny Miami and surprised me. She sat down next to me, and we joked about all of our old times. I sighed. “I miss coming home with you on Thanksgiving breaks."

“You’re gonna still come home with me on every Thanksgiving that you’re off, don’t worry,” she replied.

My girlfriends (aka my sisters) from Los Angeles, Linda and Ateena, even flew in. Ateena would help me with my daily walks around the ICU. She would hold onto my milrinone pump, and I would make jokes about how my life was always in her hands. Linda, who is one of my only friends not in the medical field, walked into the room and asked, “Wait so what's a Cardiac A-ha! diet?” 

My brother, cousins and relatives flew in and surprised me as well. “We cannot wait until you’re back in LA,” they’d tell me. My cousin and I would go down the list of everything we were going to do when I was back home on vacation some day.

A former attending of mine, someone I looked up to dearly, once came by with a David Sedaris book and a sketch pad (which really made my day). We laughed so much at my old “intern year” memories. She then showed me a part of her sternotomy scar from a valve replacement years ago. “You’re gonna be in the Zipper Club with me when you get out of here. Pretty cool, right?” 

My good friend, a cardiologist, would come by after working long hours (no matter what time it was). He knew that I was always going to ask him all of the super specific cardiology questions that my little brain had thought about all day. “Can we go over the Fick formula? Where exactly is this catheter sitting? How do they check wedge pressures?” One time, we drew out the human heart together on my iPad. I think he knew how nervous and anxious I really was deep inside. He watched me color in the ventricles. 

“So, as a cardiologist, not as my friend, but as a cardiologist … am I gonna make it out of here alive?”

“YES! Like no other! You’ll be back at work with a new heart! We’re gonna be going out so soon! First drink’s on you, though, because coming here after being a cardiologist at the hospital all day has really been taking a toll on me.” 

I wish I could tell you a story about each visitor who dropped by, but IT WOULD BE LIKE A THOUSAND PAGES OF READING BECAUSE I HAD SOOOOO MANY VISITORS EVERY SINGLE DAY!

Then came New Year’s Eve.

On this particular day, I went to the Cath lab for the umpteenth time only to come back to, literally, ten people in my room. We didn’t have any champagne, but ginger ale worked just as well. One of my friends got me Sour Patch Kids (a real treat when you’re in cardiogenic shock) and I ate the whole bag. "Cheers to 2018. Hope 2019 is a little better than this,” I said, dryly, with SPKs in one hand & a plastic cup of ginger ale in the other.

“It’s gonna be so much better. Hashtag, new year new heart!” One of them said. 

“Hashtag, can you guys go out and celebrate FOR me? All of you know that I LOVE this holiday.”

“We know that you love this holiday. That’s why we’re staying."

I fell asleep sometime around 10 or 11pm. I didn’t want to, but I did. Melatonin is a helluva drug.

Anyways, let me tell you the best thing ever right now. Let me tell you that every single person stayed in my room until midnight anyway. 

I thought it was kind of weird that they wanted to spend NYE in my hospital room.

Nonetheless…

Thank you.

My dad asked me the next morning, “You remember when you were younger, we’d always hate that you were exaggerating so much? You still always say things like ’There are forty people coming over so I have to get dinner ready!’”

“Yes."

“You were never exaggerating that much. There are a lot of people besides me and your mom who love you. You’re lucky."

Yep. And during that time in my life, I felt extra loved. My support system was actually the reason why I got through what I got through. My “enablers,” as I liked to call them. They were constantly asking the techs to get me blankets, to get me some tissues. My friend once told my nurse, “Her teeth are sensitive. Do you have any toothpaste for sensitive teeth?” (** face-palm ** SO embarrassing, I know.)

They would answer all of my medical questions when I wanted to talk about what was going on. But they would pretend like there was no invasive central line jammed into my little neck on the days that I didn’t want to talk about what was going on. 

They would hold the back of my way-too-large gown and walk around the unit with me. When I looked short of breath, they’d say that they’d want to sit down for a second (because they knew that I would never admit that I was short of breath). I knew what they were doing. 

They would bring me all of the sweets that I wanted. They’d pretend like it was theirs if my doctor or nurse walked in. Ugh, that Cardiac A-ha! diet…

They would tell me that I looked so good, even when my hemoglobin was 6 and I hadn’t waxed my eyebrows in three weeks. They would sit down and do manicures with me— even the guys who had never had their nails painted before. 

They would watch everything on TV with me on the days that I felt down and just didn’t feel like talking. They would pretend like they wanted to watch the 3rd run-through of early 1990s Forensic Files. “We’ll watch these when you’re discharged, too. I’m coming over with popcorn every night."

They would let me vent about how much my F&#(ing arterial line kept F*#$ing up. I rarely complained, but this was one major complaint of mine. “F*$& that line. It’s gonna be out in no time,” they’d say.

They would bring me flowers when they weren’t supposed to. In fact, they would bring me gifts, so many gifts, every day. I couldn’t wear shoes in the hospital, but one time, I told my friend that I badly wanted a pair of Doc Martens. “It’s gonna be the first thing I buy when I’m out of here,” I told him. He came by one day with a neatly wrapped shoebox— Doc Martens. “This is for when you get discharged. You’re gonna wear them on the day you’re out of here.”

“AHHHH! YES!!! Think I can wear these to the OR when I get my transplant?” I asked, as I checked for pitting edema before trying them on.

“You can do whatever the hell you want to do. You’re Alin.”

You see, my support system gave me a lot of hope. They’d give me hope about being out of the hospital “in no time.” We’d talk about being at work again, and how we’d be reminiscing about these terrible (but darkly humorous) times at future get-togethers. They’d tell me that, very soon, I was going to be in California and watching the sunset from my favorite secret spot in Venice Beach. And very soon, I was going to be a New Yorker living the life in the Lower East Side (my dream since I was practically five years old). According to them, I was going to handle all of this so well and so gracefully because "I was Alin” and nothing was going to stop me.

With their validating words and their incessant love for me during this incredibly insane experience, I became a little bit less scared and a little bit stronger each and every day.

I hated it at times, because I would feel like a burden. I would push them away. In fact, I got into arguments with my enablers on some days— I didn’t want them seeing me sick and barely able to walk. I didn’t want them being late to work because of me. But these crazies just kept coming back. 

So where I’m at right now in life (still smiling and still determined to kick ass)— this is all thanks to them. So, thank you— all of you— for giving me so much of your beautiful, genuine hope during the absolute worst days of my life.

And to my nurses who were taking care of me (if you’re reading this), I’m sorry for ALL OF THOSE THOUSANDS OF PEOPLE in and out of the unit every day for me.

To end this post, here are some photos of me and several of my enablers from when I was hospitalized.

Full Code

At first, it was easy. Every day, I would wake up and hope for a heart. “Today might be the day! Come on, Heart!” I’d tell people. I had my sick days, but I also had my good days, and my mind was only set on one thing: getting a heart. However, when you’re stuck in a hospital bed, you start thinking a lot. 

I was waiting for someone to die so that I could continue to live.

Let me say that again.

I was waiting for someone to die so that I could continue to live.

If someone didn’t die soon, then I would die. 

This kind of thinking really f*&%s with your head. You start thinking about how much your life is worth, who you’d want dead instead of you. And then you’d start questioning your own sanity-- if you were a sociopath or a narcissist to be thinking such thoughts. You’d feel guilty. These thoughts are raw, and they only creep up on you when you’re alone and waking up from cold sweats in the middle of the night (“It’s just the medications," they’d say). I would call those few who were closest to me (even at 4am— thanks, Matt and everybody else, you know who you are). “My cardiac index went down. What if I die tonight? Nobody deserves to die, so why am I waiting for someone else to die? What if she’s some 30-year-old in an ICU right now, and we’re just in a race to see who can die first to become the other’s donor?”

These panic attacks were terrible, but anxiolytics helped at times. Hydroxyzine 25 for mild panic attacks. Ativan 0.5 for major panic attacks. But I finally decided that I needed to really sit down with my thoughts and ask myself the real question instead of magically making them disappear for the short term with medications.

I had become really scared of Death. But why?

One of my best friends was going to do a fellowship in Palliative Medicine. I remembered her and I talking extensively about death one night, several months ago.

Death is a part of life. I told my own patients’ families this at times. I would sit down, quietly, in the family room with my attending. I would tell them everything that I was taught to say over the years, things that I had learned from different attendings. I liked talking to families. I always felt like I knew what to say wholeheartedly. So … why couldn’t I accept this easy fact, that Death was a part of life?

I was 30 years old. I had done so much with my life already. I had worked very hard to get to where I was. But remember, I had my share of fun, too. I had done my traveling, my road trips. I had explored Zion in Utah and had seen the world’s largest thermometer, the nation’s first merry-go-round, and almost all of the dreamcatcher shops in New Mexico (ask me about those later). I had tried all sorts of foods— I never said “no” to any type of food, even those that sounded gross (Anthony Bourdain was always my second favorite Anthony, next to Anthony Kiedis). I had taken more photos of the world than I had room for on my iCloud. I had jumped into so-and-so's rooftop pool (many times, in many cities) at midnight, no matter how cold it had been outside. I had gotten my degrees from several wonderful institutions, had even seen some amazing people lecture (like Dr. Jared Diamond … I’ll never forget that talk). I had been taught by the Greats of my time. I had met my favorite artists and singers (“I don’t care, we’re sneaking in backstage,” I’d say). I had read all of my favorite books over and over again. I had really never been the one to say no to anything— “Regret is the worst feeling ever,” I would tell my friends. 

I had been in love many times, and that feeling was always beautiful. I had helped save a few lives at work, and that feeling was always beautiful. And, you know, I had always come to terms with my not-so-beautiful emotions and thoughts as well. I had been comfortable with sadness and anger and the anxieties that came with this whole “life” thing.

I had been loved and supported by so many people, and I had grown into who I was today because of my family, my friends, and every single person I that had met along the path of life for these three very sweet decades. 

I guess ... the only thing I hadn’t done at this point was find that new sepsis biomarker as a freshly trained ER and ICU doctor (see last blogpost). 

Oh, also .. I had really, really wanted to go to Jackson Hole, Wyoming some day. Hadn’t made it there yet.

But I was thankful for the time that I had had. And if I had to go, I would go. I had lived a life so pleasantly that if I had died, I’d be content with Death. But if I had made it through this hospitalization, man, I would embrace the crap out of life even more than I had already done. Jackson Hole was going that much more beautiful.

There was no point in thinking too much about who’s life was more important. Thus, I came to peace with Death about 13 days into my hospitalization. 

One day, someone came in with more paperwork. She wanted me to “think about” my resuscitation status, my healthcare power of attorney (aka POA), and my advanced directive. I took the paperwork from her hands with ease, but had so much difficulty filling everything out. I thought I had made peace with Death. Why couldn’t I do this? 

I thought about all the “Code Blue”s I had helped with over the last few years. I recounted the last few moments of so many of my own now-deceased patients— from the 18-year-old gunshot wound victims to the 50-year-old cardiac arrest patients.

“He was fine just five minutes ago! I was talking to him!” a tearful sister would say.

“DON’T DIE ON US! PLEASE DON’T DIE ON US!” a crying husband would yell.

We’d push epinephrine and continue compressions and ultrasound their hearts and continue compressions and put in those chest tubes and continue compressions. It was always difficult to choose a “stopping point," no matter what the circumstances were or who was running the code. Perhaps I was lucky that I’d be able to write out who should make my decisions or what I wanted done. And those doctors wouldn't have to worry as much about when to stop resuscitation measures. 

I started thinking.

Obvious "Full Code"— I’m young. 20 minutes of CPR, that’s it. 

No wait. 

25 minutes of CPR, that’s it. 

No wait.

30 minutes of CPR, that’s it. No PEG. No trach. No, maybe just for one week. Two weeks?

No wait.

30 minutes of CPR. Make my father my POA, let him decide what to do next. 

That wouldn't work. He wouldn’t take me off of life support even if his own life depended on it. Mom? No. I literally made a list of everybody I was close with-- friends, family, colleagues included. The medical people surely would be good POAs. Maybe my best friend, the surgical resident who lives close to the hospital … no, she wouldn’t either. 

How lucky I was to not be able to appoint anybody to make my own healthcare decisions. 

How lucky I was to be that loved. 

I thought about me, braindead, with a PEG tube and tracheostomy, swollen everywhere, laying in the ICU for months. And these loving visitors would still be here every day with blankets, gifts, magazines, hugs, kisses. They’d discuss what I would have wanted. “She would have said take her off the breathing machine after 1 hour. She would have said she’s being a waste of resources,” my mom would say. “No. She wouldn’t. She’s a fighter. We can’t do that,” my dad would argue. 

I thought about the residents rounding on me every morning. "She’s an easy one to round on. No acute issues at night ... ever. She may be braindead, but nobody wants to let her go. It’s becoming a social issue at this point.” 

I was going to become a Social Issue.

How lucky I was to be that loved.

Full Code. 30 minutes of CPR. One week of life support. Donate the organs that can be salvaged.

Until next time, I suggest picking up a Dostoevsky book if you’re bored.

Only through suffering can we find ourselves.
— Fyodor Dostoyevsky

The Transplant Talk

One morning, a medical intern came into my room to examine me, before morning rounds (which is when the team discusses each patient and the patient’s care plan for the day). He put his stethoscope on my chest and listened for what seemed like an hour, but was probably more like a minute. He then apologized. “My attending today, he’s going to ask me about murmurs and gallops and he’s very strict about physical exams.” I told him that I was tachycardic, so the murmur was probably difficult to appreciate. “Don’t feel bad, man. You did a great physical exam.” 

A few hours later, the Critical Care team walked into my room. The attending asked me a few questions and then proceeded to do The Very Strict Physical Exam. 

"She has an S3 gallop. Severe mitral regurgitation. You didn’t hear it? Take a better listen.”

I quickly interjected, and told the attending that many others also didn’t notice it, probably because of my heart rate being so high. The intern had done his best to take care of me all night, and he got a perfectly detailed history on me, too. Everybody chuckled. The intern then nervously put his stethoscope back on my chest while the rest of the team left the room. “Don’t feel defeated. I know exactly how hard it all is, especially after being here all night,” I told him. 

“Alin, you know exactly what we go through. And now you know what your patients go through. I don’t know how you’re handling this so well, but you’re an inspiration to all of us.”  

An inspiration!? I’m laying on my death bed with a barely functioning heart. I thought I’d become an inspiration in Emergency Medicine or Critical Care, after doing some groundbreaking research on early sepsis biomarkers or perhaps by saving hundreds of people after an unforeseen natural disaster… 

I said thank you, and he left the room. He came back with some cookies from the resident lounge, probably something their attending had brought them. That was nice— I guess because it made me feel like a resident again (even the oatmeal cookies the attendings bring us make a hell of a difference during those long shifts). It’s the little things…

A few days later, I had a new intern taking care of me, I told her that I had this S3 gallop from my severe mitral regurgitation, and to make sure to tell the attending that. She appreciated my help. 

At that point, my heart wasn’t getting any better. I kept requesting more echocardiograms to see what we could salvage from my heart. Nope, ejection fraction still terrible. Walls still thin. Heart still looks awful.

I knew what this meant. I needed a heart transplant. I knew that this was coming, but it was hard to tell my parents this.

The cardiologists came into my room one day and sat down (they’re ALL here and they’re SITTING DOWN— this was definitely going to be The Transplant Talk, I thought). I told them the situation. “Listen, I know I need a transplant. I know you’re going to talk to me about it. I want to get enlisted as soon as possible so I can get the heart and get out of here. But the hardest part is going to be explaining all of this to my family. Instead of talking to us together, can you please just explain all of this to my parents later in a separate room? They are going to have too many questions. And I just need to be alone after we talk. I’m really sorry.” 

I hope my doctors and nurses appreciated my directness (throughout my whole hospitalization, and also my whole life— not everybody appreciates this).

We talked about the heart transplant. My blood type was B+, luckily one of the more common blood types. I would be very high up on the list, considering my circumstances. If it didn’t happen quickly, they were ready to put an emergent balloon pump in (a mechanical device that would help my heart pump, along with the medications). There was no hope in trying home infusion medications— I was too sick to leave the hospital. Things got even more complicated. I was anemic, but couldn’t get a blood transfusion (since I was going to be enlisted for a transplant). My kidney function was slowly worsening. And, remember that whole “afterload” problem? It was getting worse, no matter which medications they tried. I took it all in, and made some dry jokes about how truly ironic this all was.

“Welp, the GOOD thing is that if I ever go to the ER with a heart transplant, I’ll be an obvious admission. My colleagues are going to love my door-to-admit times. And I’ll always get to be in the Intensive Care Unit. Probably even for a both bone fracture!”

I found that the interventional cardiologists & intensivists appreciated my sense of humor more than some of the other specialists.

Finally, the Transplant Team gave me some paperwork to sign, and asked me how I was feeling. 

“Can’t go home with a milrinone pump. Yes to heart transplant. I understand the risks and benefits. Let’s do this.” And I signed the papers with confidence. I felt good. I felt like this was a step forward in my recovery— one of the hardest steps, sure, but at least we had a plan. Plus, I wouldn’t be short of breath anymore.

I swear, if you could take one thing away from me, just know that it really is a blessing to be able to breathe.

Everybody was surprised at how I handled the news. I mean, I already knew it was going there, so maybe I had subconsciously prepared myself for The Transplant Talk. But also, I never saw it as bad news. I saw it as good news— another chance at life. Look at how far medicine has come— had this been decades ago, I would’ve died (like my grandfather did, somewhere in Bulgaria, from "a strange heart condition"). But here I was consenting to get another heart. I was given this genetically defected heart that almost killed me, and I still happily used the crap out of it, and now it was time for a better one. 

My parents, on the other hand, didn’t handle the news very well. I had tried to prepare them. They were in denial, especially my dad. They came into my room a couple of hours after I signed the papers (thank you, Care Team, for taking the time to explain everything to them for that long). They were both crying.

I’ve never been a parent, but if you are one, I suppose this is hard news to process. I suppose raising your daughter for 30 years— seeing her go through grade school, seeing her stubborn personality come out at an early age, seeing her through her several Spelling Bees, seeing her the first time she drove a car (terribly), and the first time she had her heart broken, seeing her tell you that some day, she’s going to grow up & save lives, seeing her grow into everything she said she’d become ("and more," according to them) …

And then, seeing her in the Intensive Care Unit in critical condition, hooked up to monitors that beeped too much and living on multiple medications that you had never heard of, with doctors talking about shock and heart failure and the fact that she needed an organ transplant, a critical surgical procedure that would take several hours, and that her whole life would change afterwards.

Again, I don’t know what it feels like to be a parent, but I suspect that this was harder for them than it was for me.

Was I a waste of life? Was I a waste of all the love, support, time, money, and resources they had given me for three decades? Was I wasting their time? Should I ask them to leave? This was a strange feeling, but it was something that I had asked myself so many times. I had always been a practical thinker, a realistic optimist, but also a pusher-awayer. That day, feeling like an 8-year-old asking her parents why the sky is blue, I asked them, “Do you feel like I’ve been a waste of your time and resources for the last 30 years?”

They were both shocked by the question.

“You have never and will never be a ‘waste’ for us. Look at how much joy you’ve brought us. How could you even think that?”

“And what if I die before they get me a new heart? Will I have been a waste of resources then?”

Again, they were quiet.

“If you had to die, you would’ve died already,” my mom pointed out.

Then my dad continued, “Having children comes with its struggles, but there’s nothing in the world that makes me happier than my children. Anything you do, everything you do, makes me so proud. Thirty years with you was a blessing, and there are still a hundred years to go,” said my dad.

I think I knew that, but I just needed some good ol’ parental validation. I felt vulnerable. I felt so useless in this stupid bed, and not in control of my stupid, ironic life. I needed them to be my strong, superhero parents who had seen me go through it all for the last 30 years. 

And they couldn’t have done it more gracefully.

We were silent for a few minutes. There was some crying, and some hugging. And then I closed my eyes.

Now, I don’t know if the following was attention-seeking behavior, but it always made me feel at ease: When I was a child, I used to pretend to be asleep on my couch sometimes. My mom would kiss me on my forehead, and then my dad would carry me to my bed and tuck me in. They’d both say that they loved me, and then they would shut my bedroom door and tiptoe out.

Now at age 30, in my hospital bed, I pretended to be asleep. My mom walked over to my bed, and tucked me in. I heard her ask my nurse for another blanket— “She might get cold,” she said. She placed a fresh, warm blanket at the foot of my bed. Then, my parents took turns kissing my forehead. They silently stood in my room for a moment, but it seemed like a long time. And then, they both said that they loved me, and quietly shut my sliding door on their way out. 

Thank you for continuing to read my posts. Until next time,

As happens sometimes, a moment settled and hovered and remained for much more than a moment. And sound stopped and movement stopped for much, much more than a moment.
— John Steinbeck, "Of Mice and Men"

Ventricular Tachycardia

(Disclaimer: I was transferred to different hospitals a few times during my month-long battle with heart failure — hospitals will remain unnamed. Some of these stories are not in chronological order.)

In order to see how my heart was doing, the team decided to slowly wean me off of milrinone, which was the medicine that was helping my heart pump. Unfortunately, with every slight wean, I would get sicker than before. My cardiac index would go all the way back down to “Almost Death” level, and I would have trouble breathing. 

When they increased my milrinone back up, I started having bouts of “ventricular tachycardia.” We tried to explain to my parents that this was an abnormal (and dangerous) heart rhythm.

“Is this like when they shock patients in movies?” Dad asked.

Without having to go into the whole “pulse vs. no pulse,” “stable vs. unstable” explanation, I just said, “Yes.”

“No. You don’t have that.”

So, there was that. 

Sometimes, throughout my hospitalization, I would get pacer pads placed on my chest before sleeping (the ones that they use in movies to shock patients). I didn’t want my parents seeing this, so I figured out a way to use two gowns to cover up the stickers on my chest. There’s a lot you start doing in these situations so that those around you don’t feel bad for you (you’ll see what I mean).

One night, I was started on intravenous amiodarone, a medication that would help temporarily suppress these abnormal rhythms, which were becoming more and more regular.

I woke up at 2am and began vomiting profusely— on my bed, on the floor, all over my beautiful hospital gown. I couldn’t find the call bell to call for help, and so I just started screaming for something to help with my vomiting. “Zofrannnnnnn!! Please!!!!” Luckily, someone heard my calls for Zofran. My wonderful nurse came in with a basin, and told me that she had to call the resident to put the order in. 

“Can you please make sure that she also orders an EKG! I don’t want to be on two QT prolonging meds at once! Tell her I have no pain! No chest pain either!” 

And then I went back to vomiting my chicken soup and chocolate pudding. The resident came to see me, listened to my lungs, sat with me for awhile until the Zofran was given. I asked her if she would call her parents in this situation and we talked about how difficult this all was for me— trying to balance being a doctor with being a patient, trying to balance how much I was hurting with how much I wanted to show that I was hurting. I also jokingly asked her if they needed help with saving any lives out there, and she jokingly replied, “We’ll come get you if anybody needs to be intubated.”

If you’re reading this some day, I appreciated that a lot. You were probably on hour 22 of 28 with no sleep, and this patient just kept throwing up and you had so many charts to sign. But you made me feel normal, and that order of Zofran was one of the best things that ever happened to me that week.

The vomiting subsided after the medicine was given. I asked my nurse if I could try to wash my hair in the shower. She said that I couldn’t because I had a Swan-Ganz catheter in my neck. It couldn’t get wet. 

After an aid helped me clean up with a new gown and fresh bed sheets, I decided that I was still going to wash my hair. First of all, it had been over 10 days since it had been washed. Second of all, there were chunks of dried vomit creeping out of the ends. I walked over to the bathroom with my portable monitor and IV pole in place, and told my heart to please not go into V-tach while I did the almost impossible. I took a comb, wet it, and ran it through my hair for a few minutes. I used hand soap to wash out anything I could. Better than nothing. My nurse walked in and asked if everything was okay by the sink. 

“Yeah just … washing my face!” Washing the hair on my head connected to my face. 

I went back to sleep for a few hours, and woke up to my family at my bedside. They said that I looked pale and asked if everything was okay. 

“I had that weird heart rhythm again so they started me on some other medicine. Made me throw up.” 

“WHY DIDN'T YOU CALL US!!” 

My mom grabbed her purse and took out a salt shaker. She proceeded to pour salt around my bed, right onto the hospital floor. “This is to ward off evil so that doesn’t happen again. You should’ve called us."

Mom, this is for vampires I think… what are you doing…

But I let her pour a little bit of salt on the floor. She then went on to tell me that I shouldn’t have washed my hair because I was going to catch a cold (don’t even ask about this myth I’ve been dealing with for 31 years). I nodded my head, and then noticed that my dad was quiet, almost in tears.

I told him not to worry about the rhythm, that it was all under control now. My aunt called my cell phone, and then she started crying because she had heard about what had happened that night. “I’m okay! Look! I’m talking! Really! Just a side effect of the drug,” I told her.

I found myself consoling those around me way more than the other way around. I was never looking for pity, but I had to tell quite a few loved ones to stop crying and that, although I wasn’t in the best shape health-wise, I was in good spirits and wouldn’t lose my positive attitude. I had to listen to people tell me things like, “Oh, you poor thing. You had your whole life ahead of you!” and “You’re such a good person and you always have the worst luck!” and “I am SO SORRY that YOU have to go through this!”

I had to take it all in. Some days were harder than others. Just a couple of those closest to me were the only ones who would hear me vent once in awhile, after my parents had left for the day. We’d laugh and cry and be angry and laugh again about the awkward things that were constantly being said to me. My dry humor would come out with comments like, “Sustained V-tach with an index of 1.3 and all the inotropes are maxed out, dudes. They may as well get Palliative WITH Transplant consulted at this point.”

Those same close friends, all with backgrounds in medicine, would sometimes get quiet after my snarky comments. Then I would tell them that I was okay, and that I would stop joking around so much.

So that’s the thing about life. These crazy things happen. You can only control your reactions and your actions around these experiences, be as strong as possible to keep fighting (but give into your weak moments too— it’s a part of the process), and accept the fact that you need to take these damn experiences and make something of them. In my opinion, there is no point in laying around and sulking all day. There is no point in letting others’ words get to you. It won’t change the situation.

Besides, I’ve always been good at consoling others.

To end this post, here’s a quote that goes with this theme— I've always been a fan of some principles of Stoicism. I don’t think Marcus Aurelius actually said this directly because he didn’t speak English, but it sums up Stoicism pretty well:

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The Anti-Coreg

There I was, laying on the Cath lab table, the same one my own patients had laid on throughout the years while they were experiencing heart attacks or needed quick cardiovascular interventions done. I was in a surreal daze, perhaps caused by a mix of anxiety, frustration, fentanyl, and midazolam.

This is probably how my own patients felt, I thought. Sometimes, I’d go with them to the Cath lab during transport, and would wonder why they were so scared. “The cardiologist is going to take really good care of you. You’re at the right place and we caught the heart attack right on time,” I told one of my patients once. “Ah but you don’t know … this feeling … you’ll never know, Doc,” he reluctantly told me, as we pushed his gurney into the elevator.

If you’re ever reading this, Sir— I kind of know the feeling now.

Something went into my neck. 

I remember numbers being called out. I remember getting back into my hospital room, and learning that I now officially had to be transferred to the Cardiac Care Unit. I remember having uncomfortable central lines (large IV catheters) on both sides of my neck. I remember asking a resident doctor if one of them was going to come out. “There’s a risk of infection. Take one of them out, please!” I demanded. I remember someone pulling the left one out, and explaining to me that the right one had a Swan-Ganz catheter, which they were going to need to use for the rest of the hospitalization.

Swan-Ganz. This is what my attendings used to do on all their patients “back in their residency days.” Now, the cardiologists usually do them, but “we” don’t. It kind of looks like a swan, hanging out of my neck like this. When is this fentanyl going to wear off?

The attending cardiologist came into my room and explained to me that my “sats were not looking good.” After discussing my results and talking to me about our plan, the team started me on milrinone, a medication to help improve my heart function, for the time being. 

Another doctor came in to tell me some more great news. “Your SVR is over 4000, okay?”

Okay. “Cool man, thanks.” 

What’s normal though? I tried to Google what “normal ranges” were (by the way, SVR, aka systemic vascular resistance, should be no more than 1200). I had forgotten some of those basic cardiology concepts from medical school, but I was too tired to figure this all at that moment. 

I was started on some more medications to lower that great SVR of mine. I had a friendly yellow swan in my neck. I just wanted all of this to be over, so I decided to fall asleep. This was all surely all just a dream!

I don’t know how long I had fallen asleep for, but I woke up to my parents in my room with their luggage. “What is going on with our daughter!!?!"

I sobered up to reality. “I’m fine. I’m in something called ‘shock.' But they have me on medications.”

My dad then asked, “Shock? You said it was your heart, and at first it was a pneumonia…” 

Take a deep breath, Alin. 

“Look, let’s just wait for the doctors to come talk to you guys. Basically, my heart isn’t pumping well, so I’m on these medications to keep it pumping until we figure out the cause.” 

“This is probably like what I have. Remember I told you that I have cardiomyopathy? They need to put you on Coreg. 3.125mg.” 

And this became my father’s word of advice to every single physician who entered the room, from the interventional cardiologist to the transplant psychiatrist.

(One of the cardiologists patiently explained to my dad once that I was actually on the "anti-Coreg" regimen right now because my heart was in a different situation than his heart had ever been, and that this Coreg, which is a phenomenal drug for some patients, would probably kill me. He didn’t care. He was on a mission to get me on Coreg for the next few weeks. It made all of us laugh, and I appreciated how calm and pleasant the physicians always were with him.)

The team came into my room. They began going over my results.  Apparently, my “sats” were in the 30s, my “wedge” was over 40, and my “cardiac index” was 1.3. This is all Medical Speak for “We’ve confirmed that your heart is officially failing miserably.”

A lot of the work-up was pending, but the etiology of my miserably failing heart was probably familial. My father had cardiomyopathy, diagnosed around age 40. And his father, my grandfather, had “some kind of abnormal heart,” and subsequently died of sudden cardiac death in his early 40s. All of this from a mutated sequence of “ATCCTAGCCCC”s that had been brewing in my DNA for years, replicating, and waiting for the perfect moment to show itself (along with other environmental factors, but we won’t go into that).

I thought about how my genes were probably talking amongst themselves, “Why don’t we wait for her to be at the PRIME of her life, right when she’s the happiest she’s ever been, right before she moves to New York City, and then just F$&! everything up?” I chuckled and went back to listening to the physicians.

They explained to my parents that I was in a critical state. I had to be transferred to another hospital for “advanced heart failure measures” … in case the milrinone didn’t help my heart. 

I explained a lot of this to my parents as best I could. 

My parents continued to be in denial, and would ask things like “Why is the critical care doctor saying that you’re stable, but the cardiologist is saying that your labs are abnormal?” 

Because I’m stable from a Critical Care perspective, but not from a Cardiology perspective

And yes, my dad continued to ask about adding the 3.125mg of Coreg to my medications, despite being told that I needed the “anti-Coreg” to stay alive. 

So glad those days are over. Until next time!

Today’s End-of-Blogpost Treat will be a book recommendation, since I’ve been reading a lot lately. Mark Manson’s “The Subtle Art of Not Giving a F*ck” is not your average self-help book. It’s hilarious, and gives you a new perspective on life.

“The desire for more positive experience is itself a negative experience. And, paradoxically, the acceptance of one’s negative experience is itself a positive experience.” That quote (from the book) resonated with me throughout my hospitalization.

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Inconsistencies & Ambiguities

I had just seen my terrible echocardiogram, and had diagnosed myself with a sad, failing heart. I waited patiently. The cardiologists came into my hospital room and sat down. One of them asked, “Is there any personal or family history of heart failure, Alin? What exactly were your symptoms?”

For what seemed like the hundredth time, I explained. I had this cough around Halloween and it never got better. I had a cold. I was feeling short of breath over the last few days, perhaps it was due to post-viral reactive airway disease, I don’t know. I feel fine. I want to go home. 

“Any weight gain?”

“No.” But the ED nurse said that my weight was 110 pounds. I’ve never been over 90 pounds. The scale was wrong.

“Any decreased urine output? Swelling in your legs?”

“No. No.” But Matt did say my legs looked kinda swollen. Wasn’t pitting though, I don’t think. 

“Were you using more pillows at night?”

“No.” But I always use two pillows to sleep. The other night, I woke up to catch my breath. Thought it was a panic attack.

“What about significant family history?” 

“My grandma has high blood pressure. My dad has dilated cardiomyopathy from myocarditis. I think his dad died suddenly when he was in his early 40s. That’s all.” Grandpa died of sudden cardiac death at age 40…

They all leaned in. “What did he die of?”

“We aren’t sure, nobody knows. Something with his heart? It was sudden, and he wasn’t around much. It’s all unclear.”

And then we stared at each other for a few more seconds. Something in his heart, sudden cardiac death, dad has dilated cardiomyopathy, but his is from myocarditis, I think that’s what he said. Where’s my dad?! 

I frantically called my parents, who were on their way to Philadelphia. They were at the airport, waiting nervously for their plane to board. 

“Dad, I think I have to go to the cath lab. It's my heart. It’s failing. Do you remember what your dad died of? And why do you have cardiomyopathy?” 

Between my father’s hindered tears and my mother’s silence, I realized how much of my character had just spewed out. I’m straightforward. I like to get to the point. It’s the Emergency Medicine mindset, and I had always been that way. I had to go to the cath lab so that the cardiologist could check my pressures, and then something about Swan-Ganz, a possible balloon pump. Risks? Bleeding, inflammation, infection, etc. Yeah, yeah. I had consented for everything. Now, I just needed these questions answered so that I could move on with my life.

I broke the silence. "Don’t cry, I’m fine. I feel fine. I’m breathing better now, too. These people know what they’re doing." I wasn’t breathing better, but they probably need to give me some Lasix or nitro. No wait, my blood pressure. How do I do this “doctor-patient” thing?

Dad interjected. “They told us that you had a pneumonia. Are you still on life support? What are you talking about?”

I almost rolled my eyes. How could I be on life support if I’m talking. I’m on pressors-- I guess that’s life support. I stopped myself mid-thought. I put myself in their shoes for one second.

And thus came the challenging beginning of being the first and only critically ill patient (and also the only medical professional) in my family. I realized the difficulties of patient care quite early— the ambiguity, the unknowns, the constant changing-of-the-plans, the various care teams saying different things. As a doctor, I understand this completely. What I never understood was why my own patients didn’t understand this. But that day, I finally began to grasp the difficulties of being a hospitalized patient with family & friends who cared too much, had too many questions, and couldn’t grapple with the uncertainty of modern medicine.

I took a deep breath. “I’m not on life support, but I need you both here. I have to get a procedure done to see how my heart is doing. It may not be pneumonia. I’ll call you after.” 

And off I went to The Legendary Cath Lab, where I’d get all of my answers while laying flat on a cold, hard slab of metal. Where the cold, hard slab of reality would suddenly hit me.

And with that … here’s a quote (by anonymous) I recently found while “surfing the web” (like its 2001).

Fear, uncertainty, and discomfort are your compasses toward growth.

Ejection Fraction

Disclaimer: The first few days of my hospitalization were quite blurry. I don’t recall some of it because of the medications & sedatives I was on, but I do have notes written down from how I was feeling during those times, so I will be alluding to the notes occasionally.

Anyways … continuing with my hospitalization:

Nobody knew what was going on. I was extubated and breathing on my own (barely). My heart rate was too high, my cough wasn’t getting any better. My liver function tests were abnormal, my electrolytes were off. My chest x-ray showed complete "white-out" of both lungs, which is Medical Speak for “Something serious going on in the chest.”

I had almost every consulting service seeing me. I’m on my way to becoming an Internal Medicine resident’s winning case report in the New England Journal of Medicine. If you can’t tell, my dry humor got me through a lot of this.

One of the doctors in the Intensive Care Unit came to my room during the morning of Hospital Day 3. He was determined to solve the puzzle. He asked me a few questions and then proceeded to do a full physical exam on me— probably the 8th or 9th one in the last 24 hours. He spent some time pontificating about what this could’ve been, and what we should’ve done, and what the next step would be. 

He was in deep thought when suddenly he realized that he may have figured it out.

“I think it’s your heart, Alin.”

He turned to the resident physicians and calmly said, “Get Cards on board. Someone send a troponin and a BNP.” 

This is Medical Speak for “I think that your heart is failing.” He then asked me a few more questions, and we talked about the plan. The team left the room quietly.

My HEART!? My heart? My lovely heart! The one that got me through the last 30 years of my life! The one that kept me going. The one that helped me physically exercise every day. The one that helped me at work, while I ran around room-to-room in the ER trying to convince patients to stay in the hospital for their own good because I genuinely cared about them. The one that I wore on my sleeve. The one that was “too much” at times. The one that loved everything so passionately, and was always loved in return. 

I took a look at my lines and my tubes. I stared at the intravenous medications— “the drips." I was getting all sorts of antibiotics, antivirals for this possible infection of mine. My blood pressure had been running low, so I was put on a medication to help my heart pump. I had a catheter jammed into my radial artery that was reading my low blood pressure, my low mean arterial pressure (that’s the one I always look at … why’s it 60? We need to up my Levophed, guys). I then came to the conclusion that I was … pretty sick.

I picked up my pen and paper and wrote down: Heart???? I still can’t breathe. Why can’t I breathe? I feel like I’m drowning. Dying. 

A very long hour passed. One of the cardiologists walked into my room. We joked about how this definitely could not have been my heart. He then proceeded to place an ultrasound probe on my chest wall, something we do often to check a patient’s heart function.

And there it was.

Global hypokinesis. Thin walls. Dilated chambers. Chronic changes. Terrible squeeze. Severe mitral regurgitation. Ejection fraction? 5-10%. 

This is Medical Speak for “A poor, poor heart walking on thin ice.” 

He quickly put the probe down, noticing that I had seen the images already. We were both quiet for a few seconds, but he broke the silence. “I’ll be right back with a couple of the attendings, hold on." That’s Medical Speak for “You are … pretty sick.” 

I didn’t need him, or any of the attendings, to interpret anything. I knew how bad this echocardiogram was. That was, by far, one of the hardest parts of my whole experience— trying to be a hospitalized patient while, in reality, I myself was a medical professional. I had completed 9+ years of school, had finished almost 3 years of training in Emergency Medicine, and I was just about to start a specialized fellowship in Critical Care Medicine. I was supposed to be the doctor pontificating & telling young, healthy, scared, sick patients that “it" was their hearts. I was supposed to be putting the ultrasound probe on their chest walls, and ordering the serum troponin levels.

I knew how dire my situation was. I didn’t need anybody telling me this. 

I screamed a little bit, internally.

My heart, you’ve given up on me! 

To end this post, here’s something lighthearted. A direct quote from one of my attendings in medical school— a mentor of mine, a one-of-a-kind radiologist who recently texted me after hearing about my situation.

I remember you and your energy, Masha’Allah. Going through a few months of residency with a 5% EF? Only you could have done it.

That Which Does Not Kill You...

Continuing from my 2nd blog post, “Dyspnea."

Let’s go back to the night of December 21, 2018. Imagine me, nervously sitting there, in my own emergency department, waiting for my doctor to come assess me. I had just been at work 24 hours earlier, and I kept telling everyone I was fine. “My review of systems is negative other than this little cough. And don’t even worry about getting a lactate on me. It’s going to be high because my work of breathing is terrible!” I told my attending. 

If you didn’t know, doctors make the worst patients.

A few tests were done, and with some pushing and convincing, I was admitted to the hospital for a work-up of my shortness of breath. Everybody was very concerned for me. The diagnosis, initially, was that of a multifocal pneumonia— an infection of the lungs that I had probably contracted from one of my critically ill patients. What else could it be in this young female with no medical problems? No need for a lactate! She’s fine! She has work tomorrow night!

There was one major issue, though. My heart rate was too high. Anti-anxiolytics, anti-hypertensives and intravenous fluids— all useful at lowering heart rates for reasons I won’t go into right now— weren’t working for me. Instead, I found myself face-to-face with the most horrifying moment of my life. 

It all started about 30 minutes after getting settled into my bed on the inpatient floor. I remember suddenly feeling very lightheaded, as beads of sweat trickled down my forehead. The beads of sweat turned into drops of sweat. Large drops. I was feeling cold, clammy. I couldn’t think straight. I looked up at the monitor. My heart rate? 40. 39. 38. 35. 

(FYI, a normal heart rate is between 60 - 100 beats per minute.)

Suddenly, a group of doctors and nurses rushed into my room. I remember apologizing to them. A surgical resident asked if I needed to “be lined.” This is Medical Speak for “She’s crashing and needs a large intravenous line in her neck right now for special medications that need to get pushed right into her heart.” One of the medical residents gently grabbed my forearm and asked if she could check a “gas” on me. This is Medical Speak for “We are so worried about you, that we need to stick a needle into your radial artery to see what’s going on. And this is going to hurt.” I remember staring into a nurse’s concerned eyes. He was in disbelief. Please help me

Someone said that my heart rate was decreasing. Someone else called for the crash cart. This is Medical Speak for “She’s about to die.”

A nurse rushingly placed pacemaker pads on my chest, but I was so diaphoretic that they weren’t sticking properly.

I heard someone ask if they should turn this into a “Code Blue.”

And that’s the last thing I remember from my almost-death-day.

I woke up one day later in the hospital's Intensive Care Unit, not being able to recall anything that had occurred. I was intubated— tube in mouth, breathing on the ventilator machine. I was sitting up, barely. There was a parched, dry feeling in my mouth, and I was coughing up and gagging on secretions. I felt like vomiting. Restrained to my bed like a prisoner, I was in distress. Everything was so surreal. I had catheter lines coming out of my neck, my forearms, my right groin. My friends, who happened to be the wonderful nurses and physicians taking care of me, were tearfully staring at me.

My heart rate was 140. Better than 35, I thought. Cough

I will tell you— there is something compelling about near-death experiences. Your feelings are all over the place. I was so uncomfortable in that moment— I had no idea what was happening to me. But I was so grateful to be alive. I wanted this tube out of my mouth, and then I wanted to hug and kiss and thank everyone. I wanted to dance. Potential Code Blue, you lost!

I was shackled down, physically. But I had never felt so liberated, emotionally. 

To end this post, a classic from Friedrich Nietzsche (one of my favorite philosophers). Remember, folks:

That which does not kill us makes us stronger.

Celebrating Life

The story of my almost-death-day will continue later. Today, I want to celebrate life. You see, today is my 31st birthday.

I celebrate my own birthday every year, no matter where I am or what I’m doing. I think I read on a cheesy card once: "Life should not just be lived. It should be celebrated." I thought everybody did this.

When I turned 22, I organized my own “Totally 80s” house party, complete with a Pac-Man cake & cheap, colorful wayfarers for my guests. I spent the night of my 25th birthday at an extravagant restaurant in Atlanta, with a group of first-year medical students (then, strangers; now, best friends). I learned about Stylish Buckhead, and tried Waffle House waffles for the first time in my life. For my 27th birthday, I bought myself a very large lime green cake and rented out a party space in Western Arkansas. Fifty people joined me. It was the party of all parties-- fully equipped with an open bar, lots of delicious appetizers, and slices of lime green goodness for dessert. I had even invited my Rural Medicine attendings to join me. We danced. We laughed. It was a good night.

Last year, for my 30th, my boyfriend & I spontaneously took a trip to Las Vegas for one night. Our plane landed in the city at midnight. By 1:30am, we found ourselves in the VIP Section of some crowded, sweaty club listening to what kids call "House Music" these days. I spent $20 on a slot machine at approximately 3:30am at The MGM Grand Hotel— slightly inebriated, but absolutely happy. 

This year, I can’t go out to a fancy restaurant in Nashville to blow out candles, nor can I roam the colorful streets of Barcelona with friends while signing Happy Birthday to myself. Why? I’m only 2 weeks post-transplant surgery (“It’s flu season! You’re immunocompromised!” they say). But I don’t need to. I will still celebrate life.

Today, the water that I’m drinking is so pure, so clear. So delicious. I feel every drop slowly trickling down my esophagus, and I can swallow with ease. My mouth is satisfied. You see, there’s something delectable about being able to freely moisten your throat with ice cold water after being strapped down in two-point restraints, unable to clear your own secretions while forcibly breathing on the ventilator machine (twice). 

The view I’m looking at of these lovely, busy streets is phenomenal. The dark clouds overlooking the horizon, the cityscape, the flurries. I’ll be walking alongside you and your Toynbee Tiles shortly, Philadelphia. You see, there’s something sweet about even being able to look outside to gaze at something *other* than the hospital plumbing system. Liberty 1, Liberty 2, especially at dusk— I see you and I love you.

And how about those piercing, loud city sounds? To the old man who plays the same rhythmic patterns on his saxophone down my block every single night— I adore you! Wake me up at midnight, like you always used to. I was just trying to sleep soundly after those evening shifts in the ER, but I was never mad at you. Play it louder. You see, there’s something wonderful about the little sounds that you are used to, no matter where you live. The ones that don’t consist of the BEEPs, the BOOPs, and the ANESTHESIA STAT TO THE FOURTH FLOORs.

Today, I am surrounded by my family members— I’m so thankful for the ties that bind that I want to scream! Backstory? My mother has selflessly moved her life to Philadelphia for the time being to help me check my blood sugar level every morning (even though I could do it myself, MOM). 

On Friday, she heard me cry for the first time in years. I couldn’t sleep. Everything was hurting. I had stinging muscle cramps in my legs from becoming so deconditioned on that hospital bed (I was jogging every day just a month ago, MOM). There was an unbearable, raw pain in my chest from the sternotomy-- it worsened with every wincing cry & every breath I tried to take in between (Go to sleep because I’m fine, MOM). She sat next to me for two hours, slowly massaging my legs without saying a word. She let me cry. You see, there’s something special about having your mother there next to you, holding you, during those late nights when you had otherwise become accustomed to feeling cold monitor leads and wires stuck to your chest wall. The only thing you felt on those nights was the artificial touch of the blood pressure cuff clinging to your right arm, cycling itself every half-hour & reminding you of how critical your condition truly was.

Today, I honor the little things in life, and I urge you to do the same. I was never one to take advantage of these moments. But today, they complete me. You see, there’s something celebratory about being able to live after coming almost face-to-face with your own death, multiple times, in a 30-day-period.

Thank you for completing me, Everything Around Me. And thank you, My Organ Donor, for letting me continue celebrating my life.

To end this post, another one from the great Oliver Sacks, from his opinion article “My Own Life” in The New York Times. I recommend reading the whole piece here … because it will change your life.

...My predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

Dyspnea

I was settling into a 24-hour hospital shift on a cold day in mid-December, 2018. I was talking to my patient, trying to convince him to stay in the hospital. He was having an asthma exacerbation and wasn’t breathing very well. There was an obvious pneumonia on his chest radiograph, and he was requiring extra oxygen to breathe. He didn’t want to stay. He had to go home to his daughter. 

During my physical examination, I started coughing and excused myself.  “Doc, maybe you need to stay in the hospital instead of me, that cough doesn’t sound too good.”   

Cough. We laughed about it. I left the room. Cough. I went and examined my next patient.  

Cough. I got myself various medications to help with my congestion, cough, and runny nose. And then I convinced my resilient self that they were working.  

A few days later, one of my supervising doctors (side note: in training, we call them our “attending doctors” and they are our educators, role models, mentors, and lifesavers) noticed the symptoms. “Why are you so dyspneic?” she asked. Cough. Shrug

Dyspnea was a frightening term to hear. It translates directly to “difficulty breathing,” stemming from the Greek words dys (“ill”) and pnea (“breathing”). Nobody wants to be dyspneic. 

I chalked it all up to a “bad upper respiratory infection” that I was having— I’d get it checked out. The following morning, I called and made an appointment with my primary care doctor for an office visit in a few weeks.

I was going to be okay. For the next three days, I worked hard and continued to see my patients. I wrote out clinical case reports, & reviewed medical board questions. I went out with my friends, read my books, and continued to have my fun. Normal life things!!

Cough

There’s a part of this story that I only remembered in retrospect, and it “says a lot about me” (according to my close ones). I recall taking the subway to work and having difficulty going up the stairs without getting short of breath. Because I had stopped so suddenly to catch my breath, I pretended that I wanted to snap a photo in the middle of the staircase, so that the people behind me wouldn’t ask if I needed help. It ended up being a beautiful photo of the tiled subway walls, but a picture is worth a thousand words...

Dyspnea is almost always a bad sign, and I was getting worse. 

(Disclaimer: these symptoms worsened in a very short time period. I strongly urge AGAINST waiting a month to see your doctor if you are becoming dyspneic. Please use our emergency departments to get checked out if you can’t make an appointment soon enough— we are happy to help you.)

The next day was a blur, and the details will eventually surface throughout my stories. But let’s flash forward to me being forced into realizing that I needed to get evaluated by a physician. I walked into our emergency department, backpack in hand. There I was, scurrying around as a frightened, anxious patient in the Emergency Department and not as a young, confident Emergency Department doctor. Those around me said that I looked terribly sick. I was pale. I wasn’t breathing well. And how did all of this happen so quickly?  

My preliminary imaging and work-up was pointing to an infection of some sort. I was young and healthy otherwise, and the symptoms were abrupt in onset. 

But we have these sayings in Emergency Medicine that we follow religiously. Passed down by the generations of The Great Emergentologists that came before us... 

“Young people are able to compensate well... until they’re not and they’re crashing.”

With a pale, sweaty complexion, a heart rate in the 140s (normal being between 60-100 beats per minute), blue lips, and a respiratory rate in the 40s (normal being less than 20 breaths per minute), I was admitted to my own beloved second home— my training hospital, with my friends and colleagues around me for support. But for the first time ever, I didn’t want to be there. I was afraid of what was going to happen. 

Ironically, I spend hours daily convincing my own sick patients to stay because I care about their well-being. I never understood the hesitation that they had until this moment in my life. The denial that they are sick. The fear of the unknown. Cough

The rest of the details come later, so stay tuned.   

To end this post, I call this photo (taken the day before I was hospitalized), “Dyspneic in the Subway.” I know, my humor can be so dry sometimes. 

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Dyspneic in the Subway

Philadelphia, PA || December 2018