I've been back in the states and back at work for 2 days now. I. Miss. Peru. I set out to find new perspective at this point in my life, meet new people, and truly experience the soul of Cusco and Machu Picchu. I can honestly say I achieved my goal in so may ways.

My absolute most favorite thing about the trip was in fact, not Machu Pichu. I loved seeing what an incredibly spiritual place it is without a doubt. But to be honest, what I loved most about Peru was the rich culture of people that are overwhelmingly proud of their Inka heritage which is electrically still present in their blood and the genuine love for "pacha mama", Mother earth. Maybe it's just that I haven't traveled enough, but I have never met people more in touch with nature.  It didn't take long to understand that people in Cusco and the surrounding sacred valley live and die for the earth. It guides their every move and is the underlying reason in their minds for how their life unfolds. They believe that the wind can take lives as she wants, and they don't question it. It's amazing to me to be able to believe so wholeheartedly that way of life. I wish more people here adopted something like this to believe in. While I know that people there, like everywhere else, long for more money and a "rich" lifestyle, I was moved by the large number of people I did meet that were perfectly happy with their simple lives in the mountains. It was very refreshing for me to see that and a good reminder of the wasteful, materialistic lives we live here in the states.  It was such a humbling experience to share their culture.

Overall, I met some amazing people, pushed my limits physically with the hike, and really engulfed myself in the spirituality that is all around in cusco and macho picchu. I'm home now with a new perspective and goals to return to Peru very soon! :)

Here are some pics:

Initially i thought I could cross Peru off my list. But after this trip, I realized that I added abut 5 more Peru trips to the list! Pictures don't do this magical place justice. Peru: nos vemos pronto!!! <3

Thoughts from the CCU...

So it's pretty much over. The rotation dubbed, "the worse month of intern year"...is behind me!! Yay! Has it lived up to it's hype?? YES...and then some, or a lot. Mostly because we were intentionally understaffed due to the holidays thus making an already confidence destroying  and soul sucking month 10 times worse. I guess they don't want to be the main reason for the exponential rise of depression in more than 4 unlucky interns around christmas. So, I got to be one of the lucky few to experience the CCU during the holidays, how privileged I am. :)

So what makes CCU so bad you ask???

Here is my attempt to describe, with random details, the essence of CCU.

1. Cardiologistss obliviously speak their own language that nobody really understands, unless you too are a cardiologist, and even then its questionable. They presume that interns can speak cardiology the instant they graduate medical school. I mean, of course, how dare I have difficulty following what you're trying teach me right now...I'm clearly slacking since in my long 6 months of training, I don't know the intricate details of a subspecialty of a subspecialty of subspecialty lol. Shame on me.

2. Cardiologists actually believe that non-cardiologists, and possibly the rest of the world, can read their minds and know precisely what they are asking and what they want to be done. Don't forget that they are forever speaking in their aforementioned secret language.

Example:
The question they ask during rounds: "When did the patients chest pain start?"
What they actually mean: "I want you to tell me the results of every cardiac stress test, heart catheterization,  echocardiogram, and cardiac labs were back 5 years. Oh, and what they ate for breakfast on their 15th birthday."

3.  Cardiology is THE MOST evidence based specialty with hundreds, almost thousands of trials with stupid names like, "HOPE, MADE IT, SURVIVE, and BREATHING NOT PROPERLY"...seriously cardiology??? I have a hard enough time remembering the actual medicine much less the trials that proved it and how it was set up.

4. After listening to the various different ways "chest pain" can be described by the hypochondriac, psychotic, insanely old, blind and deaf, the guy who just wants to get out of his nursing home, the blissfully demented lady who probably can't remember she even has a heart, the 24 yr old kid trying to get out of the military, the cocaine addict, and the rare semi normal person that has actual cardiac chest pain, your idea that you actually knew what chest pain was, goes totally out the door. Bottom line: nobody knows what chest pain truly is, not even cardiologists though they pretend to and talk about all the different types using their language. Some days i walked away so confused about whether a person's chest pain was even in their chest. Other days my attending deliberated about the type of pain so much and went through all the possibilities and criteria that I wasn't even sure what a chest was anymore, or a heart for that matter lol. But seriously, after this month, when I hear/see the chief complaint of "chest pain" I have a feeling it's going to make me vomit or punch somebody in the face. Truth.

5. Congestive Heart Failure. Swollen testicles. Disgusting marshmallow people whose skin could potentially look like one of those egg crate mattress covers if you poked them enough. GIve lasix and wait for the urine to flow. More swollen testicles. There are no words to describe how much I hate congestive heart failure after this month. That's all on this incredibly boring and annoying aspect of cardiology.

6. EKG's. Finally starting to get the hang of it. Or so I thought. That little squeak of confidence was destroyed when asked to break down every aspect of a "difficult" EKG (fyi- a stone cold normal EKG at times can be difficult for me lol) in front of the whole team including the eletrophysiologist (best EKG readers in cardiology by the way)
It sort of went like this..

Dr. EKG: Dr. Ramirez, what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul. 

Me: Okay, a simple "wrong" would've done just fine. 


(one of my FAVE movies ps)...But that's pretty much what happened.




7. Everything in cardiology seems to have like 10 different stages an subtypes and subgroups. For example: CHF stage C NYHA class III-IV grade II diastolic dysfunction.  Do people actually know what that even means??  Really??? You might as well say CHF stage furry class 5 subgroup 6 subtype 13 grade yellow. I mean I learned it and all. But so annoying. I prefer my patient's version of classifying her husbands end stage heart failure, (in VERY heavy korean accent) "He hart no wor so good".  So much easier.

...so as not to sound like the month was all bad, here are some last good things about CCU

8. You can actually burn a line i a certain area of a persons heart with an arrhythmia and it beats better. Thats just pretty cool. Seems counterintuitive, but it works. THose really good EKG readers are geniuses.

9. You get to electrocute people on purpose, with their permission. Also pretty cool. I noticed that I was actually really interested in the electrophysiology aspect of cardiology, more than I expected really. I usually don't like things having to do with electricity, but just the idea of the heart, floating in essential water, can have electricity flowing through it making it pump sort of blows my mind. If the heart can do it, i think we can find a way to make iPhones water resistant so I don't have to replace my phone so often. Seriously, get on it apple.

10. Learning stuff. I didn't think it was going to happen this month. Interns are mostly worker bees. We do as we're told and even if we do have an idea or plan or voice, it's usually ignored. That being said, i never had any ideas of plans on cardiology in the beginning because I had NO IDEA what was going on and what I was even intending to talk about (like the patients chest pain). Not to sound utterly clueless, but cardiology is such a specific specialty, you'd be a food if you thought you actually were good at cardiology prior to intern year or even during intern year. So considering that my initial knowledge of cardiology was close to negative ranges, I feel like I did learn a lot and could possibly be approaching about a 2 or 3 now...on a scale of about 827364872648762387. But seriously, i did learn and even got a few pimp questions right from time to time. And the best part of all, aforementioned genius eletrophysiologist guy that I was pretty much afraid to even look at for fear of my life gave me surprisingly good feedback on my last day. He even told me that he thinks I could be a cardiologist if I wanted to. He crazy. Or maybe he's doing the secret language thing again and that's just code for "you're a dumb silly girl."


So it's over. FINALLY. Can' say I enjoyed it, can't say I hated it. Actually yes I can. I hated it. BUT....i did learn a few things along the way and I'm always grateful for that, it's never time wasted. Looking forward to a more normal life now.

 I'm off to Peru. To find balance and perspective again.

Ready for a break...

It has been a tough holiday to say the least. I hasn't really felt like a holiday even happened to be honest. I'm not complaining really, it's just a different feeling to know that xmas, my favorite time of year because of family time, came and went without event on my part. I could see everyone around me enjoying holidays and it just felt like I wasn't a part of it, what a weird feeling. But, i guess I knew this non-holiday holiday would come eventually. And overall, it sucked a lot, but now its over. It's the new year already and it feels like just another day. 2011 was one of the best years ever, and in some ways, the worst. The good made up for the bad and vice versa I guess. I don't really have big plans for this year in particular. I just want to live as much as I can doing the things that I've dreamed of with people that love me and do all of that without regrets. Doesn't seem that difficult...we'll see.

Anyway, i have 1 week left of CCU and it feels amazing. I can honestly say this has been the most challenging rotation of the year. Challenging in the sense that the work load has been ridiculous. It hasn't all been bad though. The days when i can barely keep my eyes open, those days are bad. The days when, because of the crazy work load, i feel like I can handle complicated patients way better than I could just 2 weeks ago are pretty awesome. Cardiology is actually really fascinating to me and if the schedule wasn't so nuts, I would consider doing it. But i'm perfectly happy being a cards geek ER doctor :) I've learned a lot and for sure still have more to learn all the time. It's been the kind of fun that i'd rather not do again lol.

Now that CCU is almost over...it's time for PERU!!!! I still can't believe that this whole thing is even happening lol. We literally came up with the idea totally not thinking it would be possible on such short notice...but here we are, 1 week away from flying to Lima. I'm so happy that it was able to be done, maybe some higher power had something to do with it because I've really needed it. After the tough holiday, tough relationship ending, tough work schedule, i need to go to a spiritual place and find perspective again. It's so easy to lose that while working all the time in an unhealthy schedule, seeing people at their worst all the time, and being around what seems like a constant stream of negativity from other overworked doctors around you. It's funny how we go to places far away from what we know to really find ourselves, there's definitely something to be said about that.

7 Days!!! :)

One of my favorite people sent me this quote today...so very true. 

“Destiny is a curious thing. It doesn’t always take us where we want to go, and many times ends up taking us to an unexpected place where we feel confused, lost, with no idea where to go next. These are complicated and painful moments that make us suffer and question who we are, along with what we want the most in our lives. But if we really make the effort to see these challenges as opportunities to find ourselves, we will understand that it was exactly what we needed to discover and strengthen our role on this planet.”
                                        [rickymartin]

peace

Source: Uploaded by user via Sherry on Pinterest

I needed this today.

Very exhausted.

More later....

What an amazing day!!!!

If my life was written as a book, (a ridiculous, crazy, emotional, weird, etc, book) Dec 14th 2011, this day, would no doubt be a very important page.

Today I found out that I will finally start my training in the field of emergency medicine at San Antonio Military Medical Center. It still sort of has not sunk in that this will actually happen in about 6 months. Although at the end of the day, I'm here, right now, exactly where I want to be, there have been times where I felt like I would never see this day.

Sure, it possibly sounds dramatic. But aside from the underlying blessings of my own health as well as the overall health of my family,  I've had days where I felt the opposite of blessed. Such days include the day when the Air Force revoked my medical school scholarship because I didn't actually get into a medical school in 2006 and proceeded to station me at Holloman, AFB in buttcrack, New Mexico to do fix airplanes. Also going down in the books as an equally "my life is ruined" day was the day when, after telling them I wanted to continue to pursue medicine, my own squadron commander and Air Force Headquarters ("The Man") told me, in not so many words, that now that I was a aircraft maintenance officer, going to medical school was not part of my life plan anymore and that I should proceed to accept the facts as a proud military officer.  Both of these epic days sprouted many other epic days that just made me really feel like my dreams were dwindling away with every day that passed.

It's pretty crazy to think back to those days and truly understand how I was able to look past all of the negative feelings of despair and not allow myself to be discouraged by the obstacles that, at the time, were everywhere I turned. I don't think I'll ever really know how I did that. I guess it's just one of those things that you don't really think about, you just do it. I remember like yesterday wishing and praying to God that if he would just help me get to this day, I'd never ask him for anything else. I remember so vividly the feelings that time was passing around me, taking my dreams of being an ER doctor with it.

That being said, it's still so surreal to me that I'm even typing this post right now. I've been fighting against everything and anything to get to this day that now that I'm here, I have a hard time actually believing it. I'm not implying that I've grown up living the life of hard knocks or anything silly like that. Simply that nothing in my life has ever come easy. I feel like i've spent my life struggling and fighting against to get here, to this day.  On the days like I talked about before (opposite of blessed days), there was nothing more that I wanted than to be finished fighting for "this life". But now that I look back, I feel like days when I felt like God or whoever had forgotten about me, were the days when I actually gained the most. It sounds all touchy-feely, I know. But no matter how many terrible days I have now, or how many times I think about how "tough" this life is right now, I look back at those days, remember how opposite of blessed I felt, and immediately realize that those were the some of the most influential days of my whole life. And without them, this amazing day, would not be nearly as meaningful.

So I love today. I love that I finally feel that some of my hardwork has paid off. But what I loved the most, was the feeling I got when I read my email telling me I was selected for Emergency medicine at SAMMC. I LITERALLY felt like the moment I read those words, the 200lbs, ever-powerful backpack of doubt and fear that I had been carrying around for a loooooooong time (even in my sleep, not just since last year) just disintegrated into thin air.

Overall, what an amazing day. I'm definitely going to bookmark this day and come back to it multiple times just so I know it actually happened.

Source: lifeslittlepresents.blogspot.com via Sasha on Pinterest

distractor post

It's match week!!!

I'm working furiously on Peru adventure planning to keep my mind off the match. I've narrowed down my flights, buying them this week!!! Hopefully booking an adventure tour that involves hiking the Inca trail..also this week! You would think all of these things would distract me from the match. (wrong) I have self diagnosed ADD so it's VERY easy for me to jump back and forth from thought to thought.

So very excited about this trip.

Other things to distract me this week: my cousin time I'm getting, the ever present ambulatory care, working out?, online xmas shopping, etc.

Ahh it's match week!!

ok, i'm done now, even this post can't distract me :(