Hahnemann Part Two

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

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

And just like that, it was going to close.

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

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

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

I was DeMarcus Cousins.

And I had to think positively.

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

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

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

This was going to be easy. Easy peasy.

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

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

And so I waited for an offer.

And waited.

And...

No.

No offer.

Of course.

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

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

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

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

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

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

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

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

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

5. When is my next Tac refill?

6. Do I need to reschedule my Cath?

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

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

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

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

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

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

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

Was this my breaking point?

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

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

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

Ugh.

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

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

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

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

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

We didn’t even know how to help ourselves.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No more sudden catastrophes, please.

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

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

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

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

Hahnemann Part One

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

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

But instead, life handed me a new surprise.

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

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

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

So...

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

Shit. THIS HOSPITAL IS CLOSING?

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

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

Anyways.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“What matters most is how well you walk through the fire.”

— Charles Bukowski

The Call

Going back to my hospitalization…

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

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

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

After a while, they let me unleash my anger.

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

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

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

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

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

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

Maybe.

I don’t know.

People are strange.

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

Anyways, back to my story.

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

And I just sat there. 

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

“Hello?”

The only thing I remember from the phone call was:

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

“Yes. I have to go call my mom now.”

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

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

And then, I felt nauseated.

And then, I vomited.

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

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

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

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

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

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

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

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

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

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

But I would get as close to that as possible. 

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

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

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

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

Everything was going to be okay.

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

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

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

I think I was handling it well.

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

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

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

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

“I probably will,” he said.

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

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

We all laughed.

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

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

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

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

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

One Thousand Visitors

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

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

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

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

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

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

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

My attendings would reply, “Absolutely."

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

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

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

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

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

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

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

I teared up.

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

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

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

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

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

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

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

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

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

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

Then came New Year’s Eve.

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

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

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

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

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

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

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

Nonetheless…

Thank you.

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

“Yes."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Transplant Talk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

They were both shocked by the question.

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

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

Again, they were quiet.

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

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

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

And they couldn’t have done it more gracefully.

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

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

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

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

“As happens sometimes, a moment settled and hovered and remained for much more than a moment. And sound stopped and movement stopped for much, much more than a moment.”

— John Steinbeck, "Of Mice and Men"