Unless They're Immunocompromised

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

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

But Cryptococcus in an immunocompromised patient? They could die.

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

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

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

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

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

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

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

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

One Year Heartiversary

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

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

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

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

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

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

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

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

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

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

Inferior. I am immunocompromised. Forever.

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

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

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

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

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

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

Anxious. I had one cancer scare.

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

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

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

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

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

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

And I continued to be thankful.

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

And that alone makes the last 365 days worth it.

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

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

Updates

Yeah, so:

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

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

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

  what

  a

  year.

Holidays 2019

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

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

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

That crazy night in the hospital.

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

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

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

Doctor-Patient Alin

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

Well, let me tell you:

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

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

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

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

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

“No, that was about me.”

And so on and so forth.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nice to be writing again. ;)

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

And with that:

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

John Steinbeck, The Moon Is Down

Updates

I know I haven’t been posting and writing as much, but I told myself that I’d get in the habit of at least trying to post something (whether it be an actual blogpost or just an update post) every other Sunday, so here it goes. ;)

• Residency is kicking my butt, and living in between two cities (in between doctor appointments at UPenn) isn’t exactly helping. But I’m doing it! I love being an ER resident again. ;) Being a doctor-patient is truly a privilege. Yes, I tell some of patients my story (and some even recognize me from the news/social media/whatever, which is even more interesting).

• I became an Ambassador for Safebeat Initiative, which is a nonprofit program aimed to help screen young people for heart disease and arrhythmias at an early age. Check out their website for more info.

• I have done a few speaking gigs since my last post, including (but not limited to 😂): FIX19, OMED, Grand Rounds at Einstein Health, Philly AHA Heartwalk. I also helped record a radio clip for Gift of Life, which should be out soon. And there have been a few more podcasts…

• OK now I feel like I’m just bragging, so I need to stop.

• Halloween is my favorite holiday ever and I spent it with my cousin, who was visiting me from California… so I’ll end the post with the photo of the night:

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

Updates

Hi everyone!

It’s been a hectic two weeks, so I’ve put off updating the blog. I actually began working again last week, which was REALLY EXCITING … until I found out that our hospital is closing and I will need to transfer residency programs. Just when you thought things couldn’t get worse, we added another CRAZY chapter to my life.

I will get back to heart transplant updates and funny stories soon … once I get my life back together (for a second time this year, ha).

But I want to put this hospital closure out there because I want people to be aware of what happens when corporations try to profit off of hospitals. Our hospital, Hahnemann University Hospital, was bought by a company called AAHS last year. Suddenly, we were told that the hospital was losing money— the company couldn’t handle these losses. And then, just like that, we were told that our hospital is closing.

Our hospital (a tertiary care center in the heart of inner-city Philadelphia) caters to tens of thousands of (mostly underprivileged and uninsured) people per year— it’s a safety net hospital here. An asset to our community.

I am so sorry to all of our patients. But it was an honor to be your doctor for the 2.5 years that I worked there. You taught me so much, & you let me take care of you. Thank you.

Perhaps we can begin making some changes in health policy because of this catastrophe. Perhaps some good will come out of this. Right?

Read more here, or simply Google “Hahnemann closure” for more information.

Graduation

This week, I was supposed to be graduating from residency. I was supposed to be moving to New York City in two weeks. My bags would’ve been packed. Boxes around my apartment would have been half-filled with memories of these last three years in Philadelphia. 

I had a photo framed from the night before [us] interns started working in the ER. Beer bottles and wine glasses in hand. Sitting around a table at some beer garden. We had cheers’d to the next three years and all of the things that we were going to learn and experience. 

I had my journal— the one I left on my coffee table for three years. I made people write in it when they would come over. Usually, they were drunk. Always, they were happy. One of the best lines that someone wrote to me in July of 2016 - “Thank you for being a living, breathing, real-life example of how life is too short and you should live every day as if it were your last. I feel like I’ve lived more in the past 3 days than I have in this entire year.”

Proud of that cheesy one. ;)

I had my candle collection, my books, my old records (without a record player, from when I was in a strange ‘hipster’ phase). All of these things would’ve been in boxes. As far as residency goes, I would have been checked off on all of our appropriate emergency medicine procedures: lumbar punctures and central lines and chest tubes. I would have finished answering some of my board review questions. I would have been getting a certificate of completion, a paper showing that I was, indeed, ready to become an ER attending physician. I would have gone out afterwards with all of my co-residents, and we would have cheers’d to the next chapter of our lives. One last “Cheers!!!”

But the things that were supposed to happen just didn’t end up happening. And here I am today, getting ready to take my nighttime medications before checking my blood pressure, my temperature, my blood sugar. Enalapril, amlodipine, tacrolimus, mycophenolate. My nightly protein shake is ready on the kitchen counter. Ugh, routine. I have a migraine headache, and it’s making me feel like I need to go to sleep early tonight. 

Of course I think about what could’ve, should’ve happened. I could have been graduating. I should have gone to the doctor earlier. And of course, there are the days where I’m angry or sad or just a little bit jealous of others my age … just casually living their best lives. They get to go to the movies without wearing masks. They don’t have to worry about death by food poisoning. And they get to drink all of the RedBull and all of the vodkas (and all of the RedBull-vodkas) that they want to.

But thinking so much about the past will never help me move on. And sometimes, I laugh about all of this. It makes me feel better. Life is funny— it shouldn’t be taken so seriously. 

Most of the time, I’m comfortable with my situation and where it has gotten me, what it has taught me. Not many get to experience this crazy but incredible thing that has changed my life forever. And so much good has truly come out of it. I’ve met so many good people (who have gone on to become some of my CLOSEST friends - Chip, this is for you), and I’ve helped a few others (or so they say). And also, I’m just a badass for handling all of it. I mean, who even goes to work a short few months after dying?

I forgot to mention … This scar on my chest is a great conversation-starter. And, as it turns out, I’m a great storyteller. Ask me about my scar, I’ll give you the craziest story that you’re ever going to hear in your life. You’re going to tell me that I should write a book about it. I’m going to give you the URL to my “Instafamous” blog.

But would I rather have just been graduating today? 

I don’t know.

To end this one, here are some of the MILLION photos I have on my phone over the last three years of residency, PRE-transplant ;)