My Life

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

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

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

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

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

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

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

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

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

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

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

And you know, I remember this:

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

But of course.

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

So I laugh.

And so it goes.

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

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

—-

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

“Get. Vaccinated.”

— Me

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:

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

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)

Pre-Op & Post-Op

They began wheeling me to the OR right around 2am. My mom and my cousin were walking down with us. My dad was on a flight back to Philadelphia. Everybody had been notified of the news. I was ready. I think.

My mom kissed my forehead. We all hugged. And then I blurted out the million dollar question, “Mom, what if I die?” 

And then she replied with the same thing that she had been saying for weeks. 

“If you had to die, you would have died already. You tried dying so many times already and you didn’t. You have a lot of things left to do in this world. You aren’t going to die.”

I’m not particularly spiritual, but in that moment, it was such a perfect thing to hear. Moms really are the best. 

The OR was so bright. I hadn’t been in one of these rooms since my General Surgery rotation in medical school. And this one was top-notch. Huge. Probably the size of my whole apartment. There were at least two large HD screens staring at me. Everything was white, blue, sterile. Cold. Fascinating. I saw a generic OR checklist up on a screen, and my name was written somewhere already.

The technicians were getting some things together. The nurses began asking me some basic questions about my birth date, my allergies, etc. I don’t know if it was because my voice cracked, or because I was unusually quiet, but I think everyone around me knew how nervous I really was.

They tried to make me laugh by saying things like, “You’re gonna be famous after this, girl.”

I reacted with sarcasm, of course. I think I asked them to try not to kill me. 

“We know what we’re doing. This isn’t our first rodeo,” they replied. We laughed some more. 

The attending Anesthesiologist came in to help with the placement of my (millionth) arterial line. 

“You know, these don’t hurt as much as I thought they would. I don’t feel a thing. I actually feel great,” I told him.

“That’s because of the Versed we just gave you.”

I chuckled.

“You ready? We gotta get you back to saving lives,” someone else said. I smiled. Yeah, I guess I did have to go back to saving lives. That made me feel better. Just a little tiny hurdle, a speedbump if anything. You’re going back to work in a few months. This is nothing.

There were a few people coming in and out of the room— making me smile, shaking my hand, giving me high fives. The CT Surgery fellow came in and asked if I had any last minute questions.

“Can you get rid of my uterus while you’re in there? Just take that thing OUT!” I asked him.

“We really only deal with the chest … but we’ll see what we can do,” he replied, with a smile.

Someone asked me what kind of music I wanted to listen to.

There was no question about it. The man who had gotten me through all of my life’s struggles. Always do your best, don't let the pressure make you panic and when you get straaaanded and things don't go the way you plaaaanned it…

“Tupac.”

And then they actually put on Tupac radio! I felt at ease. I felt good (again, might have been the Versed…). 

I heard one of the nurses say that the “heart was good to go” (I didn’t know this, but apparently the surgeons have to do one last visual check on the donated organ after it has been procured and tested extensively). They had just finished examining it, and the attending was preparing to start the surgery. “They'll all be in here soon, okay? We’re gonna finish getting you ready.”

The attending and the fellow are probably changing into their scrubs, tying their caps. They're in the locker room, probably talking about how the Sixers have been doing. There’s a medical student reviewing the nerves and vessels around the heart; she knows that she'll be pimped on them. She’s nervous because this is her first open-heart case. There’s a resident running towards the OR while inhaling a protein shake because he hasn’t eaten anything in several hours. My case woke him up from sleep. I’m sorry about that; I know how much you hate cases in the middle of the night.

Alin, this is nothing for them. It’s second nature. One beautiful incision after the other. Their well-trained, delicate hands know the ins and outs of open-heart surgery. They check off each action, one by one, in their brilliant minds. Cut here. Snip there. Be careful of the recurrent laryngeal. Remove heart.

Take my heart out. 

…

No. You know what? Violently rip my heart out of its cage! Get rid of it. This stupid heart that put me here in the first place. I was proud of you at first for living so long, but now I’m angry with you for dying so early. My life had been going so well. So well. I had worked so hard. I rarely complained. I was a good person for the most part. I did nothing to deserve this. Here I am now, all alone on this cold metal slab, just patiently waiting for the most frightening moment of my life. You’re barely working. You’ve decided to be difficult. You’ve made everybody put their lives aside to worry about me. I hope you’re happy.

I had a love-hate relationship with my old heart, but I spoke to it often. I was very open with it. (And, in case you’re wondering, I can say the same thing about most of my human relationships. Sigh.)

I felt it, though-- I was getting more anxious. Angry. Sad. Self-pity at its finest.

“Can I just talk to my mom one more time?"

“Absolutely. Here, call her,” said my nurse. She handed me a phone.

I called my mom and I told her that they were about to start. People were setting up around me. There was music playing. Things were getting blurry. I think the medications were kicking in because I started tearing up. I felt really warm.

“Mom, I’m not going to die during surgery, right?”

“You’re not. What do I keep telling you!"

“But remember, this is risky open-heart surgery.”

“But remember, you have so much left to do in this world."

I remember nothing else, other than a very distinct and overwhelming feeling of peacefulness (but again, that might have been the Versed…).

I understand the basics of Critical Care Medicine. I read the literature when I can. I know that less sedation and early mobility have the best outcomes for our intubated patients. Blah blah blah. 

“Can we just decrease their sedation? See how they do? Let’s get them off the vent by tomorrow?” I recalled asking an ICU nurse many-a-times in my career. 

Oh but I am so sorry for all of the times that I’ve done that. So, so sorry. I want my patients to do well, but I never knew how uncomfortable that breathing tube was. I would be called to go back into their hospital rooms because they were becoming agitated. “SIR, I KNOW ITS UNCOMFORTABLE! BUT JUST WAIT A FEW MINUTES! PLEASE!”

But no. No no. I didn’t know how uncomfortable it was. Now I do.

Here we were again. Me vs. The Vent. I gagged on my own secretions, and tried to grab the Yankauer suction handle. F&#%! I’m in restraints again!!! I think I was trying to scream. There were a few people around me. My nurse walked in, surprised. “It’s okay! We’ll see if we can get that out soon? I’ll be back.”

A respiratory technician came in and I kept pointing to the tube in my mouth. I started crying. Pure agony, I promise. Please someone help me, I just want this thing out.

My nurse came back in with some paper and a pen. 

Any complications?

Increase fentanyl or propofol?

Increase propofol?

EXTUBATE?

I felt like nobody was listening to me. Or reading me, or whatever. And then the attending walked in. “Hey Alin, I’ll be the attending doc for the night, okay? So we were going to extubate you in the morning, but if you're comfortable with it, we will do an SBT, get another gas, and go from there.” 

Oh, cool. He knew that I was a doctor. I liked that doctor talk. I gave him my restrained thumbs up, miserably losing my battle with The Vent in tears, while coughing up all sorts of secretions. My lips were dry and bleeding. There was sputum just slowly dripping down my chin and onto my gown. It was probably the most pathetic moment of my life. Those poor restrained thumbs up…..

(I laugh about it when I look back. Why? I came to find out later that the intensivist on call during those nights was someone who I had looked up to for years— one of the reasons why I was even going to do an ICU fellowship. I knew about his work since medical school, and wanted to be just like him “when I grew up.” Funny, right? So imagine drooling in front of your role model— just a humble, world-renowned ED/Critical Care physician, no big deal— who you’ve been excited to meet for years. Yep.)

He said that he’d be back in a few minutes, and the respiratory technician came back in. 

“We are just waiting on the blood gas results, okay, dear? I know it’s uncomfortable. I’m so sorry. Just a few more minutes.” 

I tried to glance at my ventilator settings. I passed the SBT. Please. WHAT DO YOU NEED AN ABG FOR!

Honestly, I don’t even think that I realized that I had just had heart transplant surgery. I couldn’t think of anything except getting that tube out.

The respiratory tech started setting up another oxygen machine (something we do when we extubate people instead of letting them breathe on room air right afterwards). And then, she pulled out the tube. And I took my first breath as Post-Transplant Alin. 

I felt wonderful.

I was so excited. My family was standing around me. They were clapping. I tried to feel for my own radial pulse. Top-notch! Bounding. Surreal. Beautiful.

I took a look at all of the new fun medications that I was on. 

Insulin drip? What the hell? Why do I have these wires coming out? What even is THAT wire? Do I have TWO central lines? What does that machine do? Is this a pacemaker? Why do I have a pacemaker? 

I lifted up my gown (I had no shame, ever). Woah, look at all of these surgical chest tubes! I looked at Matt and pointed to the chamber. I wanted to see how much I was draining. 

I was The Quintessential ICU Patient. Post-Op. In the CTICU. Lines, tubes, and wires everywhere. Dressings on top of dressings covering I-don’t-even-know-whats. My hair was a complete mess. My whole body was orange (from prepping me for surgery). I looked like a puffy, orange (but smiling) blowfish with wires coming out of every orifice. A child’s 5th grade science project.

Or, as my best friend (who is not in medicine), put so eloquently: “You look like an outlet.”

I guess most people wouldn’t be that excited, but when you’re almost an intensivist-in-training and also critically ill in the ICU, you may just look at these things in a different light.

And I guess that was the lesson of the day, confirmed over and over again throughout my struggles earlier this year. Your psyche, your perspective really do go far when it comes to life’s hardships. 

What do I mean?

Thanks to my mom, I calmed down about the surgery. She helped me realize that I was strong. It became nothing that I couldn’t handle. 

While I was in the OR, I was surrounded by lovely people who reminded me that they do this all of the time. I talked myself into the fact that it wasn’t a big deal— I literally knew what they were going to be doing. It became no big deal. 

After the surgery, I didn’t see my lines and tubes as painful torture devices that were there to just irritate me or perhaps leave awful scars. Instead, I saw them as incredible pieces of medical technology, each playing a major role in my healing (and some even keeping me alive). They reminded me of the reason why I had gone into medicine in the first place— why I was especially fascinated with Emergency Medicine & Critical Care: to help the sickest patients who needed the most support. I wanted to make sure that our fierce, determined attitudes and excellent resuscitation skills helped save not only their lives, but their souls. I wanted to remind them that there is so much hope and potential left, even after dancing with death and slowly sinking into the worst moments of their lives.

Sure, I was in pain, but I was lucky. It was such a humbling moment. The most humbling moment of my life.

And here is where I’ll say it: It was an honor to be in my patients’ shoes.

I’d be able to laugh and cry with them. I’d be able to physically feel their pain, their anxieties. I’d be able to read their minds— all of their thoughts about death and if their lives had any meaning at all, if they had truly lived it well. I’d know that their dignity meant everything to them. I’d know that their insomnia only came from every single one of their life’s regrets just being replayed over and over again in their heads during those nights. Every single one.

I would say things like, “MRS. SMITH, I KNOW ITS TOUGH!”...

... and I would really know how tough it was. 

How phenomenal was that? 

What an honor it truly was...

How interesting life is... 

But hey, that’s just how I saw it. 

Sorry I yelled at you earlier, Old Heart. I guess that you taught me a lot over the last few weeks.

To end this post, just remember …

…. keep ya head up.

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"