My Life

You don’t realize it. But at some point, you start referring to things as happening either “before transplant” or “after transplant.” For those of you who have gone through a very significant emotional event, an acute critical illness, a life-changing decision … you know exactly what I’m talking about.

I got my wisdom teeth pulled out Before Transplant. That trip to New Orleans? Before Transplant. And my best friend's wedding was 9 months After Transplant. Right.

Before Transplant, my biggest hurdle was, like, whether or not I should stay in to study for my exams or go out with my friends on the one night I was off from work. 

After Transplant? Every. Single. Thing was a hurdle. In the beginning after my surgery, even waking up was difficult enough. I wanted to sleep in until noon on some days. On other days, I had not slept at all and had already gone to the gym by 7am— “prednisone manic disorder” I called it. I had so much energy, and with that came a price. I wanted to be everywhere and nowhere all at once. My mind was constantly going at 100mph. I couldn’t stop, not even for sleep.

I had to get used to a lot of new things. Becoming a patient was so difficult for me. I had never been in this space before. And I wasn't just a "regular" primary patient with hyperlipidemia or a family history of osteoporosis... No, no. I was a damn complicated one with a fresh solid organ transplant. Immunocompromised. Young. The one the residents would be talking about in between their rounds— “But she is so young! Did you see her yet? In room 5?” Automatically complicated. At the least, I probably got the "Guarded Prognosis" stamp as soon as I stepped into any hospital.

Eventually, I got used to being a patient. And things slowly normalized. And you know, my life right now is pretty normal (okay, so stop laughing), or at least, pretty close to what it was pre-transplant. 

But it will never be exactly what it was back then. And the finality of that never— it will never be exactly what it was back then— will always be so difficult to deal with.

At some point, you do start to grieve the old life that you once had. And you feel guilty about it.

On one hand, you are grateful and appreciative for this second chance at life, the “gift of life.” There is so much depth and meaning that goes into everything. You don't let the little things get to you. You are more understanding of The Bigger Picture— the thing that people yearn for and never find, even after years of soul-searching and dozens of trips around the world, only to feel vastly empty in the middle of the Sahara Desert while asking themselves “Why?” You love only what you want to love passionately, and you now understand that time *is indeed* your most valuable asset. Others understand that, too. You notice the way people truly wanting to spend their time with you. It makes you feel good. People have always been good. It should have never been a question. And you try to explain it over and over again to your friends who ask you the same question over and over again. “You don’t understand, like, everything can actually be taken away from you RIGHT now, you can actually die, your life can change into a ‘before’ and ‘after’ in one second—” but instead, you chuckle and stop explaining. You finally realize what a gift it is-- to see the world in a way that most others don't, and probably never will … until it's too late. And perhaps that is what they really mean when they call it the “gift of life.”

But you did not properly mourn the death of your old life. The mundane things that you took for granted. Being able to walk around with normal, painless joints. Not having to look up which foods interact with your medications while you’re at the restaurant. A month or two without blood draws at the clinic. Waking up a little lightheaded, and actually not wondering, “Is today the last day of my life? Am I in heart failure, again?" (Surely, the next time that I’m in heart failure will be my last. Isn’t that something…) Again, it’s hard to explain, unless you have been there.

Some days are easier than others, and you learn how to process through everything in your own way. I found that my [dark] sense of humor helped me through a lot of my, ahem, issues.

And you know, I remember this:

When I was younger, I had two very big dreams. I wanted to become a doctor. And I wanted to live in New York City. Flash forward 20ish years and here I am… 33 years old, living in a beautiful apartment overlooking New York City, working at a well-known hospital, about to become a double-boarded attending physician…

But of course.

After Transplant. On tons of medications. Immunocompromised. During a pandemic…

So I laugh.

And so it goes.

Maybe we don’t need to constantly mourn our past lives. Or, at least, we don’t have to think of it as mourning. Maybe life is all about us morphing and evolving into other, newer versions of ourselves, and some versions happen to not be as challenging as others. Move on. Let it go. It's okay to not be okay, but you can't dwell forever.

Who knows? Surely, I don't have all of the answers, not yet at least. But I do know that with my second life, my “gift of life,” I still have so much to share with the world.

—-

I’ll end this one with a very special quote that will always remind us of these times:

“Get. Vaccinated.”

— Me

Doctor-Patient Alin

What is it like being a transplant patient and an ER resident at the same time?

Well, let me tell you:

I guess it’s the little things that matter, like working in that one pod with the bathroom closest to the doctor’s station is a lot easier than working in the other pods. Sometimes, my medications make me really nauseous and I just feel like I have to throw up. Mostly though, drinking all that water every day because in the back of my mind, I am constantly thinking about my creatinine level (i.e. Tacrolimus probably slowly killing my kidneys, one pill at a time, as I check my BUN:Cr ratio over and over again)... that’s a lot of trips to the bathroom.

Speaking of, it’s hard to remember to drink a lot of water during those busy ER shifts. Start a note. Sip of water. Look at an EKG. Sip of water. See a patient, return to desk, sip of water. Finish water, throw it out, forget to get more water. Damnit. I actually had to download an app that reminds me to hydrate more every day. It’s been going well. ;)

If my Transplant Team calls, I have to take the call. They are on Emergency Bypass on my cell phone. And sometimes, there are mix-ups. Ahem:

“Yeah okay so labs are good, we’ll do an echo, got it thanks bye,” I say quickly, on the phone.

“Was that about our patient in 3, Alin?” asks my attending.

“No, that was about me.”

And so on and so forth.

Sometimes, I’ll be in the middle of seeing a patient and my medication alarm will go off. Tacrolimus time. A little battle in my head ensues: rejection (my own preventable demise) vs. patient care (I do care, I promise). Sometimes, I say I will be right back. Other times, I will wait a few more moments until my patient finishes up their story. Quick physical exam. Lungs CTAB, gotta go get my Tac, will be back to finish exam. I guess it depends on the situation. I’ve mostly discovered that the best way to go about this is to just try to NOT be in a patient’s room around 9am and 9pm. Very strategically.

This is difficult in the emergency department, as people can go into respiratory distress or cardiac arrest at any time of day, at any moment in their lives. Trust me. I know.

Another thing: I know that I probably look funny. I have a mask on at all times. Some patients ask me if I’m sick and I say, “No, I just have a heart transplant, no big deal.” All have been shocked by this reply. Some have thanked me for being open about my transplant (or apologetic for asking).

Some don’t really hear my muffled voice under the mask unless they have their hearing aids in (naturally, they might have forgotten them at home). This becomes a major problem, so our nurses have to help me out with getting a thorough history.

One patient said that his own chest pain resolved after I told him why I was wearing the mask. And thennnnnnn he said something like, “Sure hope I don’t ever need one of those. Damn.” We both nervously chuckled.

I have to bring my own pens to work, and awkwardly disinfect everything my attendings and colleagues touch. I get really antsy when we have to keep switching work stations. “Can we just have a rule where the immunocompromised resident just gets to sit at the work station she disinfected for five minutes straight?” I once asked, laughingly. (This is essentially impossible at times in busy, academic ERs).

I carry Purell with me in my pocket. On my desk. In my backpack. Purell here, there, everywhere. Before, after, during seeing patients, talking to attendings, typing notes, walking to the suture cart, getting ready to leave, you name it. I use hand sanitizer so often that my hands officially look like dry, reptilian claws. I use hand sanitizer so often that I think Purell should just sponsor me. Hey Purell. I’m here.

Nurses and residents and attendings ask me things like, “How did it feel when...” and “What was the worst part about...” and no, it never gets old. I am raw and honest and I hope that they appreciate that. Sometimes, a clinical pearl or two is thrown around, all thanks to my dry humor— “Remember, no Atropine for me if I ever brady down, guys!”

And sometimes, I just have to sit down for a second. To think. I do this thing where I just stare down at my desk like a zombie (truly). Sometimes I close my eyes. Just a 30 second break. I only recently started working clinically. There is an emotional component that goes with all of this. If you only knew what it felt like the first time I heard the sound of someone getting suctioned after we emergently intubated them...

Of course, some patients do say things like, “Ah you are so young, wait until you are old and have been through what I’ve been through” or “You don’t know what it’s like to be so sick.”

I mutter, “I know, I know.” Sometimes, I wish that they knew. I can’t tell every single patient my story.

When a coding patient comes in through the doors, it’s more than just a code to me.

What I see in front of me is just another person, like you and me, who’s most vital organ has failed on them. This vital organ— the heart— capable of beautifully beating just so many times in a person’s life (I once heard about 3 billion times per average lifespan) has stopped, for whatever reason. It is now up to us to try to pump the body with blood, perfuse the organs with oxygen—with rhythmic compressions of the chest, one one thousand, two one thousand, three one thousand...

Until the heart decides: can they fix this, or am I broken for good?

Until the heart decides if it is done doing its job.

The heart *is* the most vital organ of the body. If it decides that it does not want to continue beating, after all of our efforts (and trust me on those efforts), our patient is officially dead. And just like that, in the blink of an eye, in less than a nanosecond, they are gone. Everything that they had lived for, their unforgettable presence in this world, their lovely soul ... is gone.

The heart can abruptly stop working on anybody. I have seen it all. Young, old, previously healthy, unhealthy, those with traumatic injuries, those without. Because although there are risk factors for most heart diseases, sometimes there just aren’t.

These particular moments have become extremely eye-opening for me.

And then, of course, I can’t help but think: holy shit, that could have been me.

And it’s not like I didn’t know this before. But seeing this again after my transplant surgery reminds me of how lucky I am to have been given a second one of these vital little things. Vital little powerful things.

I hope that it has enough beats left to beat away for the rest of my crazy life. I am living on borrowed time, right? Every single borrowed heartbeat is so precious to me. So phenomenal, so amazing. I still can’t believe it. It has been ten months, and I still can’t believe it.

So ... what *is* it like being a transplant patient and an ER resident at the same time?

It’s awkward and hilarious and endearing. It’s frustrating. It has made me connect with patients on a whole new level. It has taught my colleagues a thing or two about transplants.

But overall, it has made me so much more grateful of everything that has happened to me this year. Making those terrible moments— those tougher days, the pain, the lab draws, the headaches, the restrictions— seen so minute compared to what could have been....

Nice to be writing again. ;)

I’ll be trying to do blogposts (or at least updates) every other weekend. Always feel free to email me at contact.changeofheart@gmail.com if you need anything. ❤️

And with that:

“I have no choice of living or dying, you see, sir-- but I do have a choice of how I do it.”

John Steinbeck, The Moon Is Down