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.



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.


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.


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.


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:


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.)


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