Updates

As I sit here, on my bed, from my new studio apartment in New York City, I think to myself, “I FINALLY MADE IT!” I haven’t been able to blog much because I’ve been so busy. I was working a lot, and then there was that global pandemic, graduating residency, some health issues, moving out of both Harrisburg and Philadelphia… and getting my butt to New York City to start fellowship.

In between the move and graduation, we had demonstrations all over the nation (and the world) to bring light to social justice issues. I am 100% with Black Lives Matter, and couldn’t be prouder of our generation for everything that has been going on to make some changes these days.

As far as my health goes — I started having a lot of severe lower extremity muscle cramps and realized that I was suffering from statin-induced myopathy. I had to stop one of my medications and am now seeing if this is helping. Oh I also forgot to mention that I had a rejection scare in May. I had to get a biopsy done because some of my bloodwork came back a little bit abnormal— yep, it’s been a crazy couple of months.

I told you!

I mean what can I say— I am only human.

So while I try to settle some things out and start my new chapter in life, I will update you all some more. In the meantime, I am SO EXCITED ABOUT THIS. Now, onto some more unpacking.

Restrictions

Last year, after my transplant, I had restrictions.

People would ask me all the time, “Okay, like you’re good now, right?”

And I never knew how to answer that question.

Considering that I am not physically on my deathbed, but I require medications every single day for the rest of my life to make sure that my heart doesn’t stop working on me, I have to forever be careful of salads, sushi, handshakes, sporting events, being in large crowds in general, keeping my distance from you, making sure I have an extra mask on me at all times, constantly washing my hands, sometimes I forget things, there’s this one thing with my sternal wire, oh excuse me my alarm just went off—

I guess I am good now, yeah.

I was taking a train somewhere last year and there were not many seats left except for the two seats in the front of the car left for people with disabilities. I wanted the least “crowded” area of the car and didn’t want to be sitting next to a [virus and bacteria carrying] stranger. I was still just a few months out of transplant. I stood in front of one of them, didn’t even sit on the seat, when two women came by.

“These seats are for elderly or disabled people.”

I told them I was sorry. I got out of the way.

“You young people, you don’t need these seats. My mom has arthritis and I have to sit with her so we are taking these seats.”

“That’s fine, I wasn’t sitting there, I was just standing in front of it.” I didn’t even want to explain the whole me-distancing-myself-from-everyone thing at this point. No one understood this concept. I took out my mask and wore it for the train ride, while standing in place.

She looked at me. A lot of people did when I wore a mask.

“What are you? Sick?” she chuckled.

I annoyingly said, “No, I got a heart transplant a couple months ago and this is the first time I’m on a train. I have to wear a mask everywhere and I keep forgetting to wear it.”

I think she was embarrassed after this. She turned beet red, and apologized multiple times throughout the train ride. She offered her seat to me. I kindly declined.

And you know what else?

I hated wearing my face mask. I wore it all the time when I first got discharged. When I first started working clinically, I pretty much wore at least a surgical mask (or N95 mask) at all times in the hospital. My face would break out in pimples. My ears hurt from the ear loops. I had headaches. So many headaches. And how did my doctors think I was supposed to drink all this water if I was wearing a mask the whole time… I have accidentally spilled water all over myself many-a-times while trying to drink water through my mask. Yep.

Stores might as well be closed, I thought to myself during my quarantine. I couldn’t get my nails done. Infection risk, they’ll be touching me, close contact. I couldn’t go to TJ Maxx and buy all of their discounted anti-aging face creams. Infection risk. Too many people around me. My discounted anti-aging cream obsession had to be put on hold for a few months.

I had to get used to exercising at home, especially if the apartment gym had more than 1 or 2 people working out in there. I bought a stepper off of Amazon and watched YouTube videos on how to work on everything from tight butts to arms to abs all from home. Because heart transplant patients’ number one worry should always be tight butts and abs.

I would walk from my couch to my bed. My bed to my couch. Take selfies. Post on Twitter about taking selfies. Read. Board review. Walk to my couch. Look outside. Binge-watch true crime everything. Read Board review. Take selfies. Rinse, lather, repeat. Google Hangouts and FaceTime were awesome— but even those got boring. There just isn’t much going on, I love my new heart, it wants to be OUT out with you all already! I would say.

There was a little bit of anxiety that came with going back to work in the beginning. We see thousands of weird infections in the ER… who knows what I could be exposed to… could this be the last patient I ever see, as I would intubate an elderly patient in respiratory distress (in a mask and yes, eye gear too, always). But it got better with time. I was always very careful about my use of PPE, and my colleagues all knew about my situation and never hesitated to help me out if I asked for it. Ever.

My home became my everything. My own space became my sanctuary, some distancing from others was good… and this became an incredible part of my recovery. I learned so much about patience and myself. And now, I just feel like all of this is normal for me. None of it bugs me— I don’t feel uncomfortable in my space, I don’t feel loneliness at home. I am a little anxious about COVID-19, sure, but overall I know that we will get over this as long as we continue to work together.

Once this is all over, you will never take advantage of being outside with people. You will never take advantage of busy streets with crowds, people laughing, people yelling. You will never take advantage of having wine and dinner with your friends, of the waiter coming to your table asking, “And would you like to hear our specials for this evening?”

You will never take advantage of being able to breathe fresh air without a mask ever again. And you know, your ears do eventually stop hurting once you get used to the mask. ♥️

To end this post:

• Podcast recommendations: This American Life (heartfelt storytelling) & Reveal (the best investigative journalism, in my opinion) have both had some amazing episodes in the last 3-4 weeks about COVID-19 and how different people are dealing with it.

• April is Donate Life Month!!! 💙💚 Make sure to consider becoming an organ donor if you aren’t one already. You can SAVE EIGHT LIVES and IMPROVE THE LIVES OF ~100 OTHERS if you do become an organ donor! Click “Organ Donation” above for more information.

The Otherwise Healthy Population

I was once 30 years old. Healthy. Not a care in the world. Invincible. 

I, a young physician myself, had only been to a physician’s office just a handful of times in the last ten years of my life. One time, I had battled appendicitis and had a little scar to prove it.

Completely healthy otherwise.

Invincible.

There is, however, that small percent of “healthy people” who suddenly get so sick that they require life-changing interventions— including things like ventilator support and organ transplants. 

We glance over that small percent in medical school— “healthy people, no, rarely do they get sick.”

With COVID-19 going around, infecting both the young and old, the healthy and unhealthy, and even the invincible, I’d like to tell you what it’s like from a first-person perspective ... what it’s really like to be sick. Not just “I think I have a cold” sick. This is “worst case scenario” sick. Because this might, in fact, help you realize what kind of situation we are dealing with. And how seriously you should be taking this. 

When you first get intubated, you don’t remember anything. I didn’t. The only thing you do remember is how difficult it was to breathe right before you got intubated. You remember, for the rest of your life, coming to terms with your death (peacefully), you remember the sweating, feelings of heaviness in your chest, and you remember the panic and the tension in the room— nobody was expecting it. You apparently look at your colleague and the last thing you say is, “Please don’t let me die tonight.” This will haunt them for the rest of their medical career. 

When you get extubated, you are awake for minutes before extubation. Minutes feel like hours. You gag on secretions as your visitors stare at you. Your dignity? Lost. You cry from the discomfort. But you have to wait. As soon as the endotracheal tube is pulled out, so are a lot more secretions from the orogastric tube— they were both in there together. You are immediately put on high-flow oxygen, which is perhaps even more uncomfortable, because your mouth is kept dry. You are thirstier than you’ve ever been in your life, but you can’t drink anything. You beg for ice chips. You feel nauseous. You may have laryngeal nerve paralysis from your (two) intubations. I didn’t have a voice for two months after this and had to see an ENT doctor for follow-up— apparently, this is quite common.

The ICU— one of my favorite places to be as a doctor— is the worst place to be as a patient. You are constantly being reminded of your impending death. Your vitals are being checked by the minute with your arterial line that never seems to stay in place (it needs to be replaced more than once)— and none of them are ever normal. Your blood pressure is always too low, your oxygen saturation is always too low, your heart rate is always too high. When they fix one thing, another one worsens. It’s a delicate balance— trust me, I know. 

You are taken away from your room to get procedures done every few days. It’s exhausting. Sometimes you wonder if things would have been easier if you had just died those few invincible days ago. 

You see your dad cry. A lot. In 30 years, you have never seen him cry. 

You see the stress that you are putting on him. He starts having chest pain one night but doesn’t want to go to the ER to get evaluated. He minimizes it. Your mom minimizes it. You don’t have the energy to feel guilty anymore.

You never sleep. You are tethered by wires and tubes to a stiff bed and you can’t lay down comfortably. 

You never sleep because you are afraid that if you fall asleep, you won’t wake up the following morning. Sometimes, when you’re sleeping, your heart goes into ventricular tachycardia and you don’t want to be sleeping through that. That’s how I justified it. It doesn’t make sense, but a lot of things don’t.

You finally get your life-saving heart transplant— the one you never knew you needed. The one you were told that young people likely never needed, because young, healthy people rarely get sick. If you eat right, exercise, live an active lifestyle, live a good life, become a productive member of society... why would you ever get so sick? So suddenly?

Because sometimes, things happen. 

You get that transplant in just a few days— days— and you get discharged. Your life is forever changed. You work around alarm clocks for your medications. You stay away from crowded places. People stare at you as you disinfect your plane, train seat— your new normal is understanding that you are now (officially) the opposite of invincible. Incredibly vulnerable, in fact. You know that your life won’t be as long as you once thought it was going to be. But, on a positive note, you see things in a new light— even the mundane things are more beautiful, you are more grateful for each day, and you will never take advantage of your health ever again.

Because yes, at one point in my life, this crazy thing did happen.

And I’m here to tell you that these things could happen.

So please stay safe out there. If you feel like this is nothing, and this can’t affect you, and you’re healthy and invincible...

just remember that there’s always a small chance that you’re not. 

And I hope that you never have to go through what I went through to prove this.

——

To end this:

• The latest on heart transplant recipients and COVID-19 can be found on https://www.jhltonline.org/ — so far, low numbers, but little to no evidence to support that “healthy” (aka no other co-morbidities) heart transplant recipients are at higher risk of COVID-19 complications than the general population (YEP, I know, but read the data yourself before coming up with any conclusions). Promising! 👍

• I’m doing fine, thank you for caring & asking. ♥️♥️♥️

• I love all things “Alice in Wonderland” (fun fact) so here’s a good image to end this post with:

Updates

A few things:

• I wrote a post (called Life & Death) that was supposed to have been published last Sunday, but I forgot to click the “Publish” button then. So you get two new posts today.

• COVID-19! What does this mean? It means a lot. I think that everyone, not just high risk and immunocompromised patients, should be worried. I am still working (I obviously can’t work from home), but I am being extra cautious (as I always am), and this is a risk that I am willing to take. If you have to travel, live or work in an area with a high COVID prevalence, then perhaps it’s best if you stay home. If you do not feel comfortable doing something, then don’t do it. Simple as that.

  • If you are feeling sick, you should DEFINITELY be staying home or going to the nearest ED for help.

  • KEEP WASHING YOUR HANDS!

  • For transplant patients: Some FAQs answered here.

• Overall, I have faith in our system. I know that my hospital has plans in place and I feel well-prepared for any potential outbreak. I am taking all necessary precautions at this point. What more can we do? Be prepared for the worst. Hope for the best.

• I did a podcast for WebMD and you can hear it here. I had so much fun recording it. I think it’s probably my favorite interview thus far. :)

• Remember last year when I did my FIRST Keynote Lecture at, of all places, FIX19?! I know, I couldn’t believe it either. It’s finally up and running on the FEMINEM website. In it, I talk about the importance of physician empathy when it comes to treating patients. Enjoy!

• Oh, and final update. Here is a photo of me at CRT2020:

I was a Keynote Speaker at CRT2020 at the end of February, a conference for interventional cardiologists. I spoke about my experiences as a patient and how its been changing my practices as a physician. LOVED being there!

Life & Death

When I first became a transplant patient, someone pointed out that one of the hardest things was going to be dealing with the deaths of other transplant patients. The truth is that we don’t always live as long as the “regular” population, especially those of us who are transplanted at younger ages. Two weeks ago, my friend Ali died in her sleep. She was a 24-year-old woman with a heart transplant (and so much more). She was strong; she helped me through my early days as a baby transplant patient. She wrote a book by age 23 about overcoming her struggles throughout her life and advocated so much for organ donation. She was intelligent, hilarious, and kind. Rest In Peace, Ali Neff. ♥️

And, you know, I see life and death around me often— it’s a regular part of my job. Some people are just living to die, others are dying to live. I see a reckless 30-something-year-old woman purposefully overdosing on cocaine just to see what it feels like, just this one time. Next to her, there’s a patient, a former marathon runner, who has beat cancer twice, and he can’t breathe that well right now. I am about to tell him that the cancer is back. For a third time. In his lungs.

I’m not here to judge who deserves to live and who doesn’t. Never, ever. I’m not here to question why some terrible things happen to good people, or vice versa.

Life is life. Some of us are given long, beautiful ones. Some of us are given short, awful ones. Sometimes life is long and burdensome or even troubling … who knows.

One thing is for sure: life is what you make of it. Life is how you react to everything that happens to you. Life is a special gift if you want it to be. In my opinion, it is extraordinary. We do our best to live a dignified life and leave behind what we can, if we can. So simple, yet so complex.

Unless They're Immunocompromised

I am almost done with residency for the second time, unless another unexpected life event happens (for the third time amirite!?). And I thought about writing this post as a resident in the midst of studying for my boards. Let me rephrase that— as an immunocompromised resident in the midst of studying for my boards. So this one is for the residents out there. <3

We learn about rare diseases all of the time. And usually, they are no big deal for The Regular Population. The Immunocompetent.

But Cryptococcus in an immunocompromised patient? They could die.

You don’t have to worry about the treatment of mild Salmonella, well, unless your patient is immunocompromised.

And remember, if you come across a patient with the flu, they’re likely safe to discharge. Unless they’re immunocompromised.

Generally speaking, if a patient comes into the Emergency Department with a fever and no other symptoms, recheck their temperature. Reassure them. PO hydration. Discharge. UNLESS that patient is immunocompromised. They need blood cultures and the whole work-up. Admit to the ICU.

My friends laugh with me during lectures every time I roll my eyes when I hear something about how “immunocompromised” are at risk for XYZ. And then I remind them that “immunocompromised” doesn’t just refer to patients with organ transplants. There are a lot of people— including healthcare professionals— who are on various immunosuppressants. They just don’t blog their lives out like I do.

People ask me how I work in such a high-risk environment with “germs everywhere” (as if germs aren’t anywhere else, as if I walk out of the hospital into Sunshine Heavenly Sky City made of cigarette-smoke-free and Tuberculosis-free air). How do I deal with the anxiety of constantly being reminded of how quickly I can get sick and die, whether it be through my environment or through my textbooks? I don’t know how I do it. I guess I’m a little bit strong. I guess I find some humor in it all. Life’s too short for all the anxiety we give it; it deserves less anxiety and more serenity.

I will admit one thing, though: I love continuing to work in the ER because I know that if something were to suddenly happen to me, I would already be in the BEST place I could POSSIBLY be in. In the whole entire world. By chance.

To end this little post — a reminder to everyone that February is Heart Month. Know your risk for heart disease, don’t smoke cigarettes, eat your fruits & vegetables, and remember to try to exercise for at least 150 minutes per week (hey, even walking counts)!

Liz and me at the American Heart Association VIP Kick-Off Party for AHA Philly at The Ritz Carlton earlier this month.

One Year Heartiversary

One year ago, on January 15, 2019, I received my gift of life. Over the last year, I have felt it all because of this gift. My heart has brought me anger, happiness, sadness, excitement, and everything in between. Just like a good heart should.

So for my anniversary, let’s run down A Year’s Worth of Emotions, brought to you by my recycled heart:

Grateful. I’m living on borrowed time— every second is a blessing. Even the rainy days are beautiful. The worst of times are, in a way, the best of times. I told you once that I read somewhere, “You have to die once to really learn how to live.” It’s true.

Helpless. In the beginning, I needed help carrying things, like mail and groceries and bags. I was so ashamed of this. My mom had to help me take my first couple of showers because it was too hard for me to stand up since I was so de-conditioned from being in the hospital for a month. Sometimes, I still need help with heavy grocery bags. But I could shower by myself nowadays.

Bitter. Why did it have to be me? Why this age? Why at this time? Bitter feelings come and go. And they go, I promise you. But they can’t be stopped from coming.

Amazed. HOW IS THIS TRANSPLANT EVEN POSSIBLE? I ask myself this every day. I am in the field of medicine and I still don’t know how this is a thing. Sometimes, I wake up in the middle of the night and think to myself, “There is someone else’s heart inside of me right now.” And then I smile and go back to sleep.

Isolated. I was quarantined for almost three months. I had to sit with my own thoughts. I had people come and go, and I had social media to always turn to. But nobody really knew exactly what I was going through. And the thought of knowing that my life would never be the same as it was in November of 2018, the highest point that my life had ever been, gave me the shudders and made me feel quite lonely. I still feel lonely sometimes.

Creative. Canva became my best friend, and so did blogging. No seriously— I started Skyping with the good people of Canva & they loved my story enough to possibly use it for a new campaign.  You all should use Canva. It’s amazing. They’re not paying me for this, I promise.

Hurt. Physically hurt from all of the trauma my body went through in the beginning. Afterwards, there isn’t so much pain. Right heart caths are done through the internal jugular vein (aka central line) and those don’t hurt … until you’re trying to sleep on your right side at night and it’s sore. Nothing some Tylenol at 2am with ice on your pillow won’t fix as you’re trying to get some sleep for your 7am ER shift. Telling the central line gods that you’ll never do a central line on anyone ever again if you could please just get some rest right now.

Bored. I watched so many Persian soap operas with my mom for those first three months that she stayed with me in Philadelphia.  So many trips to A.C. Moore on Broad and Chestnut. So many friendship bracelets made. So many random greeting cards made and never actually sent out to people. Rubber stamps. So many rubber stamps.

Inferior. I am immunocompromised. Forever.

Annoyed. Tac level 7.1 repeat Tac level 15 repeat Tac level 5.8 repeat Tac level 21 and on and on and on…

Overwhelmed. Remember that time I got a heart transplant, and then my residency shut down, and then I had to find a new residency that was 1.5 hours away? And then I had to commute with the train in between cardiac catheterizations and I was exercising every day because health matters and my parents were calling to make sure I was okay all of the time and I was studying for boards and making sure I was taking my meds on time because rejection and…

Awful. Ugh, those side effects in the beginning. Meals didn’t taste so good. Moonface. My hair was falling out. Migraines. I embarrassingly went to the emergency department for chief complaint of “whole body pain” (which exists!) and I hated myself for that.

Burdensome. It seemed as though people were always afraid to be around me in the beginning. “Are you okay?” “Do you want me to get you anything?” “I cleaned my apartment for you!” “I’ll wear a mask if you want to come over.” “Do you want to sit? Are you okay?” I am sometimes afraid to tell others that I’m feeling sick or have a headache because most of my friends are doctors and I feel like they’d bring out defibrillator pads in an instant. And of course, the non-doctors would just call 911.

Jealous. I am so jealous of my former co-residents who were able to graduate to go onto their attending jobs and fellowship positions. They don’t know how lucky they are. I sometimes wonder about how much different things would have been if I hadn’t gone through any of this. If I had just lived the rest of my life like I was supposed to. And the thought stops there.

Loved. Between the thousands of texts, phone calls, visits in the hospital to the thousands of people I have never even met in real life who have been with me through social media …. I have no words. I just know that I love humans. That is all.

Anxious. I had one cancer scare.

Guilty. Someone else died in order for me to live. And do I live this life for her? With her? Who’s heart is this? Does it matter? Why am I beginning to ask these questions? 

Empathetic. I was putting a hemodialysis line on a sick, comatose patient the other day and I walked through the whole procedure with him in the room. Step by step. Just me and him. “It’s about to be a tough few days for you, I know.”

Hopeful. The field of organ donation is getting so much recognition nowadays and I hope that I am helping out with that.

Inspired. To make a change in the world. Sounds cliche, but I swear that I’ve been saying this since I was a young girl. It’ll happen. Just watch. This year made me feel more inspired to make a change than any other year in my life.

I think that, most importantly, I felt— and continue to feel— thankful. 

Not just thankful because I received a second chance at life. I am thankful for the outpouring of support from people all over the world emailing me on a daily basis. I can’t even believe it anymore. Those messages have kept me up all night and have made me cry. I am thankful to have become somewhat of an unofficial advocate for people who have been afraid to speak up about their own ailments. Even transplanted physicians emailing me, telling me that my story inspired them to open up about their own— there shouldn’t be a stigma. Thankful to be asked to do talks and lectures on the importance of empathy after going through what I went through. Thankful that I found a group of young women with heart transplants, now some of my closest friends, via social media who I can talk to every single moment of the day. Thankful to be writing (on my blog, others’ blogs, for magazines, for medical journals, and even for The Philadelphia Inquirer— I mean how is this even possible?) … and having others connect with my writing. Thankful to be asked to become a representative for women with heart disease for the American Heart Association. Thankful to help doctors and nurses, my own incredible colleagues, realize that what they do matters— I am a living testament to that. Thankful that, because of my story, hundreds of people have messaged me throughout the year just to tell me that they have registered to become organ donors.  And wasn’t that what I had set out to do when I first started blogging, on post-op day 7, while I was in my hospital room and all of you were rooting for me? I didn’t know how the next few days, weeks, months were going to pan out. I didn’t even know if I was going to stay alive to continue to this blog. But I stayed alive. And I continued to work, to advocate, to love, to write, to spread my story.

And I continued to be thankful.

Thankful that, at least with this terrible thing that happened to me, some kind of good came out of it. 

And that alone makes the last 365 days worth it.

Thank you for your love, support, kindness, and everything in between.

To end this post: here’s a photo I took when I was home (Los Angeles) two weeks ago and my favorite part about it is the [tiny] moon. I have a thing for dusk and the moon.

Updates

Yeah, so:

• I went home (to Los Angeles) for the first time in almost two years last week and it was pretty nice, but I think that my heart is set on staying on the East Coast. I’ve been saying this since I was, like, three. I think I can officially say that: I left my heart in Philadelphia. Right? ;)

• It’s been a crazy time at work. Just wanted to remind all of you doctors, nurses, techs, PAs, medics, all of you … that I love you. Thank you for what you do. Please read my little thing in JACC if you are ever feeling jaded. It is free to download and I heard that it’s a tearjerker.

• IT’S ALMOST MY ONE YEAR HEARTIVERSARY! WHAT THE F&%#! HOW. DID. THIS. HAPPEN. Here is a “gallery” of some of my memories of this year. Old heart to new heart, prednisone weight gain journey, starting to exercise all over again to forgetting to exercise because work’s in the way all the time (hashtag resident problems), being on the red carpet with some amazing gals… what a year…

  what

  a

  year.

Holidays 2019

I have no official “beautifully written” post today, other than to say:

I can’t believe it’s been a year since I almost died!

I have never been much of a Christmas person. I actually really don’t like the holidays. But I feel like, for the rest of my life, this “cheerful” season will come and go with lots of extra weight for me. I can look at it in a positive light— I survived the worst thing that could have happened to me. But I just can’t help it. Walking around Philadelphia and remembering how much I was struggling with each step, how much I was [probably] pretending like everything was okay.

That crazy night in the hospital.

And every night I spent in the hospital afterwards, throughout the holidays, just hoping that this was all a dream and that everything would go back to normal soon enough.

As humans, we naturally associate memories with certain times, scents, feelings…

And I suppose this will be my forever association. And as the years go on, the holidays will slowly become an easier time for me. But I am only human, right? ;)

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