Bullet Barf

•  I have too many thoughts running in my head today, and I've come to the realization that I am more dishonest with myself than I've realized. So here it goes in barfy bullet format:
•  I am currently on vacation. I can't even begin to describe how relieved I am. I also feel a little like I shouldn't be feeling this way? I had an entire month of research elective in March. I wasn't totally chilling--I still had to go to clinic two half-days per week, and I still had to attend conference. But my mornings were mine; I was running on the treadmill every morning, sleeping full nights, and just generally taking better care of myself.
  
• Being in fellowship is constantly feeling like you don't know anything. For me, it's even worse than in residency. There's always this nagging sense that you should be reading more. Not to mention that every attending evaluation will say something along the lines, "Sophelia should continue to read more to further her knowledge base."And yet, there's a stack of Blood journals from the past three months collecting dust on my desk. 
• Seriously, how am I going to feel ready to practice after three years of fellowship? I'm almost one-third of the way there, and I only feel slightly less dumb than I did ten months ago.
  
• On that note, I am probably going to forget everything about hematology by the end of this month, because I would much prefer to not do any reading in the next two weeks.
• We are going to Hawaii on Friday. I am looking forward to the change of scenery. I am looking forward to not having to answer any damn pages or e-mails. All I want is to eat and hike in peace.
• Until Friday, I have been forcing my butt to sit down and write.
  
• As I have mentioned multiple times here, I have two main writing projects in progress:
• EP is the light of the life and the bane of my existence. To recap this long-ass saga, the story came into being when I was fifteen years old and obsessed with Phantom of the Opera and alt rock bands, which materialized its first iteration on fictionpress.net. (Is that website still alive?). I wrote intermittently in college until I finally finished a full draft in medical school. You know when something has been brewing for too long and it ends up turning out mushy? That's kind of what happened. And eventually, the fire that had pushed me to write EP for so long just slowly kind of... petered out.
  
• Med Rom Com (I still don't have a catchy title) started stewing in my head while I was in residency. I wanted to write about residency, but I didn't want to write about myself. The characters came to me first, and it was a way for me to document and process what I was going through. Plus, I was convinced (and had gotten advice from others) that I needed to put EP aside because it was driving me bonkers.
  
• But then, once I started really trying to write Med Rom Com, it became clear to me I wasn't over EP. Under all the overcooked slabs of fat on that story were the shiny little pieces that made me remember the joy. You know when you're submerged in a deep writing session, and when you emerge from the trance feeling like you absolutely NAILED it? And when you read those parts again, you're like, Damn this is good, did I write this? 
• It's like that scene in the Pixar movie Soul where the artists are in this area called "the zone" which I guess brushes up into the afterlife. It's a spiritual plane.
  
• I've mentioned before that I started listening to the Fated Mates podcast during the pandemic. Romance author Sarah Maclean has spoken before about how debut novels have a certain edge to them. It feels like when someone has been voraciously reading for ages, and over the years, they've collected all their favorite tropes and bits and let it percolate into an amazing blast of excitement and freshness. She and her co-host Jen have also referred to "writing to your id," which refers to certain aspects to a story that give your brain that euphoric hit of PUT IT IN MY VEINS. 
• Once I heard that, things started to make sense. EP is essentially a blend of all the things Sophelia has been hardwired to react to on a primal level. (i.e. masks, secret identities, musicians, gimmeeee)
•  So, essentially, I realized I wasn't ready to write off EP just yet.
• But at the same time, I know logically that it might be time to just let it die. My mother had the analogy of watercolor painting, where if you keep trying to go back and fix with water and paint dabs, it'll end up a mess. 
• I've been writing on most Sundays with a Zoom writing group hosted by Laini Taylor. As I've written on this blog before, when I discovered her book Daughter of Smoke and Bone back in college, I inhaled the first two books and pre-ordered the third book (which is not something I typically do). I've also proselytized her books to numerous friends... Anyways, it's a little crazy to me when I think about how I'm doing these Zoom writing sessions with a writer whose work I've admired so much?
  
• She called me out and asked what I was working on, and I kind of rambled a bit. But I mentioned that I was working on something I'd set aside for a couple years. And she mentioned something about how it's always neat to get a fresh perspective with the distance of time, but also to be careful of mucking around on something for too long.
• WHICH IS EXACTLY WHAT I'M WORRIED ABOUT.
• But really, all I can do is stop wallowing and just swing for the fences, go hunting for big game. Which is easier said then done. I almost feel like I need to be super rigid with myself and give myself deadlines and scheduled writing times, because otherwise I always find excuses.
• But this is only possible on vacation, because when I'm in work mode, I constantly feel like I should be studying... reading... so that I don't screw over my future patients...
  
• I'm about to turn 31 years old, and there's this growing feeling of fear. Fear that I've been stuck in inertia, and one day I'll look back and think about how I squandered my potential. 
• But I guess again, the only solution is to just suck it up. And just do the work. 
• Finis
  

Excerpt 1.0

When you have cared for hundreds or thousands of patients during residency, there are names you will never forget. They are structural beams in the blueprint of a physician, a piece of your humanity preserved in amber that your fingers idly skim across years later. 

Guadalupe Fuentes. Was this during the first surge, or the second surge? To Elise, it has been all the same, a single monstrous swell rising and rising towards an infinite height. Seven months ago, Elise was the overnight MICU resident when Lupe was transferred from the floor. 63-year-old woman with diabetes, contracted COVID from her 87-year-old father who was briefly hospitalized for a few days and had already made a complete recovery. She’d initially required 4 liters of supplemental oxygen on the floor and had been started on Dexamethasone and Remdesivir, but that night, her oxygen requirements suddenly increased. Rosy apple cheeks and impeccably arched tattoo eyebrows, Lupe was always awake when the night team passed by her room, flashing a thumbs-up through the window as the high-flow nasal cannula obscured part of her face. 

Her final night is imprinted upon Elise in pieces. 

The alarm of the bedside monitor ringing, the blue numbers never rising past the 80s, shallow fluttering breaths as the respiratory rate climbs to the 30s, then 40s. 

Martha Fuentes, holding it together just long enough to say goodbye to her mother over Facetime, her voice cracking before a trickle becomes a rush of sobs, begging Elise to take care of her mother. Theo, the MICU fellow, calling out the orders for rocuronium and etomidate from the head of the bed as he wields the blade of the GlideScope in his hand. Elise, foolishly placated by the calm that follows a smooth and uneventful intubation. Foolishly lulled by the back-to-back success of her flawless placement of a central line catheter and arterial line, with Theo remarking that Elise was ready to do the procedures solo. 

Fool, fool, fool, fool, she has told herself a thousand times since. 

The phone rings while Elise is signing out overnight events to the day team. Her intern announces that Bed 40 is coding. Dread strikes like electricity shooting from the roots of her hair, through her scalp. Theo is already gowned up in the room when Elise gets there, calling out orders for one amp of sodium bicarbonate, one milligram of epinephrine. Elise jumps in to perform the next set of chest compressions, the sweat dripping down her neck under the gown as she feels the ribs rolling under the clammy skin beneath her gloved palms. They achieve ROSC after one cycle of CPR, but then the oxygen saturations drop and they are coding her again, three more cycles of CPR. Finally, they call it. Time of Death, 7:04 AM. 

She remembers how Fortino spared her from having to call Martha, telling her to go home, that he would take care of everything. But as soon as she was alone in the call room, Elise could no longer move, body dull as lead as the last gasp of adrenaline abandoned her. She sat on the bed in a daze for what felt like hours, until Rigo entered the room. It’s funny now, when she remembers how awkward things were between them back then. Neither knew how to behave around each other after what happened in Vegas. Trapped together as the night float residents for their respective MICU teams, she couldn’t look him in the eye as he stood in the doorway. 

Hey, are you okay? 

How many times had she been asked that question before and answered with a lie? Before she could even get the words out, the tension in her facial muscles gave him the answer by letting go. 

This was the last time Elise cried for one of her COVID patients. How many others has she lost since then? Ten? Twenty? Fifty? The story repeats itself, one by one, the bodies in her mental graveyard lining up in rows. Dexamethasone, full-dose heparin drip, Nimbex drip, Vancomycin, Cefepime. Nothing works. They slip through her fingers one by one like sand.