2/7/2016
St. James Hospital
Fort Wayne, Indiana

Alexandra Taylor came in for a previously scheduled Cesarean Section. She and the baby were healthy, but wanted to go ahead and have a C-section instead of normal birth. Alexandra is a 29 year old female who is underweight, thinner than recommended by most doctors to keep a baby healthy. The baby was brought to term but I expect it to have some learning and developmental disabilities. The C-section went smoothly and everything looks good. The baby has no complications and is staying with her mother in the new mother’s hall on the fifth floor.

Joseph Velasquez

2~7~16
St. James

Today I had a sad case. It was supposed to be the best day of these parents, the birth of a beautiful baby. The mother was so nervous for many days. Alexandra Taylor. She’s a very small woman, and that’s why the case didn’t turn out to be regular. The baby was carried until the very last day, but Dr. Velasquez informed myself and the family that the beautiful baby girl, Elyse, may have some disabilities. Even after a flawless C-section. Nothing too serious, he says. But he does not know the feeling of hearing your child may not be the normal perfect you expected.
I have no kids. I have no husband. But I can feel their pain and relate. I felt it as soon as I heard Dr. V say those terrible words. I could see the helplessness of the father and the distress of the mother. We spent a very long time talking about it. We talked first about the emotional task. I felt as though I was lifting their weight...and it all crashed down on me. I wished for anything but this for their baby. Elyse is the most precious thing in the world to them. She is their first child. Alexandra is young, and her husband is strong. They are living the life of people who have so much ahead of them. Their future isn’t written; Elyse was their future. But now instead of a blank page, it is a foggy swirl of dust.
We don’t know yet. We aren’t sure. I told them that over and over. I tried hard not to cry as I watched the young man and his wife sob and bawl and wail. After we talked about the emotional distress of the baby, we talked a lot about options. We talked about different types of developmental handicaps and played out some scenarios. They seemed to feel a little better when they heard the chances of their baby’s defect affecting her life.
Since we aren’t sure yet, I’m going to keep with this patient until we find out what kind of life they are going to be facing. St. James offered to place the family with another social worker, as is standard. I’m really only a surgical social worker and sometimes emergency room as well here at St. James. But I’m going to stay because I want to see this baby off to the best life possible myself.
When you think about it, it’s not as sad as it could be. But the parents act like it’s the end of their world, which means it has to be the end of mine. They told me that Alexandra’s brother has some mental disabilities. His case is severe and he is not able to dress, feed, or wash himself and can say only three words. He is 26 years old and Alexandra spent her whole life “making up” for her brother as she put it. And now she feels like she let her husband and her family and her baby down.
I’ll see them tomorrow. I’m sure I’ll come up with something to say to gently put it in perspective.

Cristina Johnson

2/21/2016
St. James Hospital
Fort Wayne, Indiana

Justin Vale, 18 year old male with some obvious health problems (overweight, extremely poor hygiene, can not walk due to his fat to muscle ratio) was diagnosed with appendicitis yesterday and his appointed appendectomy was today. The appendectomy, to me, is the most simple procedure. A few cuts, a pull here, and there’s the appendix. It does not take too long and I do not get tired standing there over the patient. This patient was different. He was so overweight I had to first resect some of his built up fat to access his organs. I managed to get part of the appendix, the most diseased part, but there’s not a way to tell if the appendicitis will come back. Personally, I’m not inclined to think it will, but there is a chance. I will continue checking up on him for a while.

Joseph Velasquez

2~21~16
St. James

Justin Vale is 18. 18! He could have a family, and kids, and a good job, but instead he is stuck. He can’t even walk. He hasn’t walked in over a year. I’ve never seen anyone so unhealthy. His hair has fallen completely out. He was two teeth, that’s it. He has red eyes all the time and we ran drug tests. He doesn’t take drugs, at least not now. He seems to be telling the truth when he said he’s never even tried a single drug once. His hygiene is just that poor. We had to use a gigantic tub for this 500 pound teenager and we must have scrubbed 3 layers of dirt. He lives with his mother as well!
His mom, Esma, is also overweight and unhealthy. She has grease basically dripping from her hair. She has no visible teeth. She walks, but barely. Really more like toddles around. His dad, on the other hand, is the picture of health. Maybe a bit on the skinny side even. He has nice, white, straight teeth and a full crop of dark hair. He is well dressed and stands up straight. He has wonderful manners and charms all the doctors. Nicholas is what hospitals put on billboards to make them seem like they are the best place to get healthy.
Nicholas and Esma first got divorced twenty years ago after being married for less than a year. Then they hit it off again at a bar and had Justin and got married again. But five years later they got divorced again and Esma completely let herself go. She wasn’t a parent to Justin, she gained all her weight, right then and there, and she slipped into filthy misery. Nicholas moved to the other side of the country before this and called three times a year, but never knew the extent of the damage. He flew in when he heard his son was going to surgery.
He cried when he saw what had become of his once family. He showed the doctors pictures of a beautiful, slim, graceful woman and a healthy little boy. Hard to believe it was once the people I see standing before me today.
I had to explain things many times to Esma. She did not understand that it was possible for her son to get sick. Nicholas was very good with her. He hugged her and comforted her and helped her through it all. He took her to a hotel where he had her shower for the first time in who knows how long and bought her a pretty new dress to wear. He really cleaned her up. Tomorrow he’s taking her out to a dentist and doctor. We started discussing healthier lifestyle options for Esma and Justin. Nicholas decided that he’s going to stay in Fort Wayne until they get back on their feet.
I can’t fully tell if Esma has a serious mental disability, or if years of living in squalor has dimmed her mind. Nicholas speaks of a brilliant woman, who he had to scramble to keep up with, and that amount of deterioration is something I’ve never seen before. Justin seems to be completely sharp. He responded well when I told him I would like to see some healthier changes. Nicholas went out and bought clothes for him because according to the frightened Esma, he has been wearing the same t-shirt for almost a year now.
I felt bad immediately for cringing in disgust when I first saw them, and for the disturbed look I must have gave when I saw the picture of the happy woman, but I am not alone. Doctors shy away from the room and extra spray has been placed there for the smell that goes with this poor family.
I am recommending a fat-removal surgery that will point Justin in the right direction. Esma may want one too, although she is not as bad off as Justin. I am going to have Justin enroll in college, go to physical and occupational therapy, as well as a support group for people trying to lose weight. I have a specific diet planned out that I sat down with a dietician for hours about and we have also arranged an exercise schedule. It’s pointed towards intervals, so he will build and eventually get to full scale diet and workout. Nicholas will ensure he does all this. We have made similar plans for Esma. I will continue to work with them until they are back to completely healthy. And perhaps then Dr. Velasquez will go back and take out the rest of his appendix.

Cristina Johnson

3/4/2016
St. James Hospital
Fort Wayne, Indiana

Patric Harris is 17 years old. Male, extremely active and fit. Hip replacement scheduled almost a month ago.
Athletes. They always need surgery designed and used for old people when they are young. I’ve never done a hip replacement before in a person under the age of 60. That 60 year old was a year ago. I had to spend an incredible amount of time training for this surgery. It took more than 8 hours to perform as well. However, it went well. I am confident that he will be back on his feet in no time at all. He woke up from his surgery about three hours after we brought him to his room and he seems to be feeling well. He should start physical therapy very soon.

Joseph Velasquez

3~4~16
St. James

A young football and hockey player came in today. His name is Patric Harris. He is only 17 years old. He has such a cute family. I had worked with them before, obviously, to decide if this was the best treatment for him, and today was game day. I knew that his little sisters needed some extra support. He has six little sisters, Emma, Lindsay, Claire, Peyton, Grace, and Julia. Their mom and dad, Brent and Cassandra, are polar opposites. Brent is a strong, sports driven man who coaches more than four sports for a living. Cassandra is a smart, talented artist who looks like she can barely hold a feather. So their kids are a wonderful blend of athletic and intelligent. Emma is 13 and she’s already committed to college! Lindsay and Claire are both soccer prodigies. Peyton is the best singer and painter in the state, and she wins all kinds of awards for her art. Grace is a model for a junior sports wear company. And tiny Julia is still a baby. At first I couldn’t believe the 17 year age gap. And Cassandra is still very young!
It was Claire who was most worried for Pat’s surgery. She’s only 8 years old but she somehow understood the risks of the surgery more than her sisters. Or maybe the other ones just don’t  care that much about their older brother. After all, less than a year away he’ll be in college. Julia won’t be 1 yet. Grace is five. Peyton is 7, Lindsay is 11. The only one who spends a decent amount of time knowing him is Emma. But she’s 13. She’s starting to have other things on her mind. I don’t blame her. Not even in highschool yet, but committed to some college on the east coast. She’s a quiet girl around here, always on her phone. Her parents tell me she’s usually very talkative. I hate to see a different side of her; it makes me impossible to reach her. She doesn’t seem to care.
Pat, on the other hand, is so sweet. He’s an honest guy, an open book. He confides in me about a lot of stuff. His teammates, his friends, all of it. I didn’t care that he talked for hours about nothing, it was okay. He seems comfortable here. I like that. But I do have to do my job. So I had to cut him a little short and go check on my other patients. It’s okay. I can see him tomorrow.

Cristina Johnson

3/25/2016
St. James Hospital
Fort Wayne, Indiana

I am not a person who goes deeply into a person’s life. I see a medical problem, I treat it. And often this means going into family history, but there is no reason at all for a long spiel about Mom’s dog’s sister’s cancer and how the son of the mother of the wife of the cousin of the brother won a soccer tournament. I simply need to know what kind of diseases or syndromes my patient possesses from his DNA. Scientific reasons only.
For some reason, 55 year old Mike Mitchell did not understand this. I tried to distant myself, but all he could talk about was the death of his wife. Four months ago. She didn’t die of heart failure, and didn’t need an angioplasty like he did, so there was no need to talk about her. She was hit by a car. Healthiest woman in the world, he said.
Mike died on the table. A simple, flawless, angioplasty but his heart just didn’t beat. It wouldn’t start. There is a psychology involved in surgery. If before you go under anesthesia you are happy, you are more likely to have a better outcome. The same works vice versa. Mike was unhappy. Depressed. Couldn’t stop talking about it.
In my job, “I feel” is a phrase I do not use. But today, I feel sad and sorry. Because he had a wonderful chance. This angioplasty could give him new life. But instead two kids lost their mother and father in a matter of four months. It’s just sad. And I deal with death all the time. But the fact that I could have comforted him in the room, maybe to better my own medicine, could have changed the outcome.

Joseph Velasquez

3~25~16
St. James

Four months. Four months, that’s only 16 weeks. Two kids. Ellen and Nicole. Ellen is 14. Nicole is 12. Four months ago, their mother died. And today, their father died. In four months, two happy, complete children became orphaned. They have no aunts, no uncles. Their grandparents on one side are dead, the other are too old to care for children. I have to place them with an adoption or foster agency.
They say it could have been avoided. They are upset because they believe that if their father had gone in less upset about their mom, then he would have come back. They say he gave up. It’s not fair. Dr. Velasquez says the same thing. He said his surgery went perfectly. But he just didn’t live.
Ellen and Nicole are staying with me tonight. They have no place to go. They can’t go home. So they are staying in my apartment for the night. Maybe a couple more.
It’s really hard for me. I bring this stuff home and don’t have anyone to talk about it with. So most of the time it just fades away after a while. The joy and the sad parts. But this time I have living memory in my home. I can’t do it. I almost turned them out a couple times when they were sitting there huddled on my bed, crying. They didn’t get to even see him. Dr. Velasquez immediately sent him to autopsy.
A simple angioplasty. Velasquez does them all the time. But Mike Mitchell didn’t want to wake up again. He left to join his wife. He left two kids. He left a whole life. And they are alone and they are scared and sad and hurt and wished they had just one parent to comfort them. I’m doing my best but it’s not enough. I really can’t do this anymore. I’ve started showing all clinical signs of depression. I don’t know why. I didn’t lose my parents at a young age. I just watch people do. As a social worker, I am highly aware of the signs to look out for in a patient. I meet those signs right now, more and more in my everyday life. I just can’t keep letting myself fall away, off the edge of the cliff.
Tomorrow will be a better day.

Cristina Johnson

4/15/2016
St. James Hospital
Fort Wayne, Indiana

Maya Carey found out a couple months ago that she carried the cervical cancer gene that killed her mother, aunt, grandmother, cousin, and sister. She is 30 years old and with her genetic counselor decided to have a hysterectomy to remove her uterus. There was a slight complication when we in fact found an existing tumor, but we removed it along with her uterus. She is now completely cancer free. She was surprised and upset to find out she did in fact have cancer. Her fiance, who at first didn’t want her to get the surgery, was glad it was done. There was a lot of emotion in that room. Anyway, I harvested stem cells so if they want to have children we can grow them in a surrogate mother or incubator.
I tried to put her in a great mood before her surgery. She was nervous but completely ready to go. And she had a great outcome. She’s fine. She’s okay. The cancer won’t return. She’s happy, too. Glad she did it. I don’t know why something is bothering me, but I’m glad I could help her out. That’s my job as a surgeon.

Joseph Velasquez

4~15~16
St. James

I dealt with a difficult case today. Maya Carey is engaged. She also has a gene that will probably give her cervical cancer. She’s lost everyone to this small little gene. Her mother Olivia. Her grandmother Mia. Her aunt Abby. Her cousin Grace. Even her sister Molly. So she got surgery to remove her uterus. But her fiance obviously wants kids. Maya’s only 30 years old. She could have a lot of kids. But not if she doesn’t have a uterus. But she wanted to make sure she wouldn’t get cancer.
So she finished her surgery and found out she actually had a tumor. And she cried, and he cried, and there was tears and crying. And usually I cry too. And I comfort and I’m good with them. But this time, I just stood there. I gave some hugs, a pat on the back here or there, but I just stood there for a while. And I felt better. Because I didn’t take an emotional toll from a patient’s tumor that isn’t even there anymore. She doesn’t need any cancer treatment. And to top it all off, Dr. Velasquez actually stayed this time. Usually he sees emotion and flees the scene but he stayed for a while and I actually saw him smile. Which might be a first for me.
A lot of firsts for me. First time I didn’t cry when the patient did, first time I saw Velasquez look happy. But at least everything ended well. And I don’t have to see their tears in my dreams because this one I’m not taking home.

Cristina Johnson

5/3/2016
St. James Hospital
Fort Wayne, Indiana

  A simple procedure today. Cholecystectomy. Removal of the gall bladder. Laurel Christopher, 24 year old female with multiple gallstones and a recurrent cholecystitis. She was in a lot of pain before she came to get help. I went to her family to talk about it and they said she was in sports training for college and wanted to “tough it out.” I feel sorry for her, gallstones are incredibly painful and cholecystitis is more. She played softball in college and trained year round. I can’t imagine her pain.
Anyway, the surgery went well. She will no longer have to tough it out for anything. Her family thanked me over and over. Laurel is in a great mood and she wants to get back to the field. She’s now in an adult league winning all sorts of awards. That’s always nice. So is a good surgery.

Joseph Velasquez

5~3~16
St. James

Laurel Christopher knows how to overdo it. She’s a dedicated softball player with a history of not reporting the extent of her injuries. Like when she dislocated her shoulder and still pitched 4 innings. And now, she had gallstones and never mentioned how bad the pain was. Always called them cramps. Her family has been worried sick for three years but she wouldn’t go to a doctor until she graduated college and finished her final softball season.
Her surgery today removed her gall bladder. It went well. I didn’t go to the post op check-in, I visited her and her family later once everyone had settled down and emotions weren’t flying quite so high. Her whole family was there to help her when she woke up, as well as three of her teammates.
Her dad, Dan, is a mechanic who won’t stop comparing surgery to repairing cars. Which really helps her brother, Chris (why they named their son Chris Christopher is beyond me) who has some learning disabilities and happens to be in the family business. Her mother Paula is a sweetheart. Brought the whole staff cookies. She opens her house to anyone who wants to stay and from what I can understand she has teammates, friends, homeless people, and random people traveling in the area staying at her house all the time. So basically she runs a free shelter. One of the homeless children she cares for is an orphan, her single mother died in the Christophers’ house, so she never leaves Paula’s side. Hannah. Cute little girl. Seems to like Laurel enough but is terrified of Dr. Velasquez.
Her teammates were fairly quiet. They only talked to Laurel and they only talked softball. Many times I had to ask whether or not they understood the surgery or the risks or whatever they wanted to know. Only the main leader of those three girls, I didn’t even catch her name, talked to me. They were actually wearing their uniforms. Along with hats. And carrying a softball each. What, do they live in those things?
Laurel will recover fully. She will get back to her game and I will get back to mine. And I will not worry one more second about those strange teammates who I hope will not come back tomorrow.

5/29/2016
St. James Hospital
Fort Wayne, Indiana

When 48 year old Caitlin Prescott came in today for her long awaited liver transplant, she already knew the drill. She has had liver cancer and a transplant before this. She doesn’t drink, or smoke, or do any other drug, she just keeps getting cancer. With her first liver, the one she was born with, she had cancer for a year and it went away after some treatment, then came back two years later and stayed for six years until we decided to transplant. The new liver got cancer and has had it for almost three years now. She will get one more transplant and then UNOS has decided that if the cancer comes back we will only treat with radiation and chemo for 7 years. If the cancer does not go away by then, UNOS will have some decisions to make.
I have seen Caitlin through a lot. Her husband has been with her this whole time too. She first got her very first cancer when she was 30. She was a newlywed, and it was diagnosed only about four weeks after they were married. She found out she was pregnant a little later, but not before she had been to a round of chemo, and the baby was a miscarriage. She could never have children because she was always going in and out of chemotherapy and radiation therapy. They considered adoption, but Caitlin was always so scared that the cancer would kill her leaving Ethan alone with a child and a child having to see a mother that isn’t even his or her own die.
They decided that they are adopting as soon as this surgery ends. They are adopting an Ethiopian orphan named Adanya. It means Her Father’s Daughter and is beautiful. The adoption agency has agreed that tomorrow, one day after Caitlin’s transplant, they will give the happy couple their family.
The transplant was a huge success. I think I tied off a vein that was hosting the main cancer cells while I transplanted this new liver. Caitlin, Ethan, and Adanya should not have to worry about liver cancer anymore.

Joseph Velasquez

5~29~16
St. James

Caitlin Prescott is a regular visitor. I’ve been working for a long time with her and her husband Ethan. Ethan Prescott is a worried man. He is worried about everything, and can’t seem to slow down. He lives life at a pace twice ours, and no one can really explain it. He’s in the moment but he’s also in the moment that will occur ten minutes from now. I’m not going to clinically diagnose him with anything, but if I did I would be interested to see what it is. He goes so fast, worrying about everything, and poor Caitlin watches as she wishes she could keep up.
They’re having a baby. Adopting a sweet little girl. Adanya. I met her earlier today. Adorable. She doesn’t seem to care that her father lives in a different world than the rest of us, or that her mother might die at any minute. She’s only a baby but she’s bright. I gave her a few blocks to play with and she built a very tall tower, taller than her. She also made a stepping stool out of blocks to reach the top when it got higher. I’ve never seen a baby do that before.
Caitlin should be cancer free. She should have been after the last liver, and the time before that as well, but there’s nothing to explain this but extremely bad luck. We tried to send her to drug and alcohol rehab, but they sent her back saying she had never even had a sip of alcohol in her life. And she never used drugs either. It is the strangest thing. No one in her family has had lung cancer. But at least she has her daughter now, and Ethan who will live a step ahead of her forever.
After her liver transplant, Caitlin was upset. She was upset because she was scared. So she was crying. Then the adoption agency person put Adanya on her lap, and she cried because she was happy that she had a new daughter. Then she cried because Ethan was gone and she wasn’t sure if he was ever coming back so she was sad. Then when he did come back just a few minutes later because he was only getting Adanya a snack, she cried out of relief. I felt bad for her, but after a while I had to leave and let her figure it out. It was hard for me. Usually I can just stay there for hours, watching and looking and seeing. But Caitlin made it quite clear with her tears that she needed to be alone with her family. So I tore myself away. It was hard, but I did it.
I can see her and Adanya and Ethan tomorrow.

Cristina Johnson

6/13/2016
St. James Hospital
Fort Wayne, Indiana

Connor Miller is a father, husband, lawyer, son, brother, uncle, nephew. He’s also an organ donor. I harvest organs all the time. But I have never had to tell 3 kids and a woman that their father/husband is brain dead after giving them so much hope of a full recovery. He was in a car crash. He was going to work and a car crashed and he couldn’t stop in time. He’s the only victim. He was 53. I spent all day with his family after pronouncing him brain dead. I can’t push organ donation on anyone, so I showed Ava Miller where her husband’s organs would go.

Heart- 40 year old man, Max Jones, father of eight
Liver- 14 year old girl, Isabella Sanchez, ballerina and 9th grader
Kidneys- 4 day old boy, Billy, life still unwritten

And so on. Ava took pity on those people and offered them up. So I harvested his organs. I sewed him back up after, and made him look completely normal, and let his family take him to bury him in their own way.
I can’t stop seeing the kids’ faces. They wouldn’t leave when I had to tell the mom so I told them too. I told them that their Daddy wasn’t waking up. Henry, the oldest, is 16. He knows what brain death is. He understood and had to explain over and over to the younger ones which had to be extremely painful for him. Amelia is 12. She likes the hospital. Before her Dad’s surgery, she explored and even helped out the nurses. But when her dad died, after they pulled the plug, she stayed in one chair and has been there ever since. Henry can’t lift her up, she’s gripped onto that one chair and she won’t move. Devon is the littlest. 8 years old. She doesn’t know her father is dead. We told her over and over, but she saw her father lying in the bed, heard the heart monitor beat a steady rhythm, and so she believes. She believes that he will open his eyes, give her one last hug, say he loves her.
Amelia is the most distraught by far. Apparently before she left the house that morning she was arguing with her father about not being allowed to go to a sleepover and she didn’t give him a hug before he left the house.
Usually I do not hear these stories. I do not want to listen. Dr. Johnson, the social worker, always handles them. But today I didn’t leave. I stayed all day. And I listened. And it was sad, but it was good for me to know the story, so that when I send away the organs to save lives, I respect the one I lost.

Joseph Velasquez

6~13~16
St. James

Organ donations are a tricky business. And I am excellent with them. I am excellent because I have compassion. And I never say anything about that, but today was different. I couldn’t bring myself to hand one more crying mother and wailing children a box of tissues and listen to them. We had an organ donor just a couple days ago and I spent so much time with them, I couldn’t do it again. So I stayed with the kids while they pulled the final machinery away, sat with them in the chairs outside the room, but I didn’t even learn their names. Instead, Joseph Velasquez stayed with them, all day. He is slow and awkward. But he tried really hard, and I think the wife knew that.
I gave the widow her kids back after the whole thing was over, but one is old. Teenager old. So he was the real one taking care of them. And after they left I sank to the floor and I cried. I cried so hard. I don’t know why. I didn’t get close to them. It all happened relatively fast, and I didn’t step in until the very end was coming.
I know now that I couldn’t do anything to comfort that family. I can try, for sure. But nothing I say can help them get over the loss of a father and husband. Every patient, I try to totally reverse their emotions, make them swing back to happy, and I think now that it was a mistake on my part. I should have let them go. They need time to mourn, I can’t save them from everything.
So I walked away from this one. I walked away from the pain it brought me to watch them, doing nothing. And I really did do everything I could. Because in reality, I can’t do anything for them.
Yes, I am excellent at convincing a family to consent to organ donation. But there is no excellence with comfort. There is just...none to give.

Cristina Johnson

6/30/2016
St. James Hospital
Fort Wayne, Indiana

The spine is a tricky business. I tried everything. I really did. And there was no way I could have seen what was coming. I would never have even tried to help Grace McDonald. 35 years old. Such young potential. A husband, a new baby. Another one on the way. But she lost everything today. In my OR. In my hands.
Regret is something I don’t feel very often. Especially when a surgery went well. It wasn’t me. It wasn’t her. It just was. Spinal stenosis is something I have seen many times. I have performed surgery on a couple patients and not one of them had a bad outcome. There is no reason for Grace to have this happen to her. So I regret...well, I don’t know what to regret. I guess I regret that this happened, but I don’t know how it did. All I know was, she woke up. And she is completely paralyzed.
Neck down paralyzation. From a spinal fusion. I have been on the phone with doctors for  hours trying to find a way to possibly reverse it. The family is devastated. This means putting all thoughts of a normal pregnancy out of the window. I am really at a loss here. And I feel so sorry for them. I just want to apologize and say it’s all going to be okay. But I can’t. Because I don’t know. I have run every test in the book. Nothing. And it’s frustrating, another emotion I don’t get very often and when I do I never express it. But it really is.
I am going to go call a hospital in Sweden to see if they have answers.

Joseph Velasquez

6~30~16
St. James

Neurology was never my strong suit. Psychology, yes for sure, but neurology and brain surgery has always had me shaking just a little bit. And today the brain surgery that Doctor Velasquez performed and left a woman paralyzed made me want to shake a lot. But I didn’t. I was there and polite, but I didn’t get too involved. The woman is pregnant, so I discussed life options before I turned her over to a life long social worker that will handle the rest.
Calling the social worker was the best thing I can do for myself. As soon as I walked in the room and saw a crying child, a crying man, and a woman hooked up to endless machines with a baby bump, I had my phone out. I still spent the better part of an hour with them, and I did learn the husband’s name, but I think writing it will just trap the sadness right here, in the book. Being detached is what has saved me from these past few cases. It has saved me from myself. And every once in awhile I relapse, but I always manage to tear myself away in the end.
I am a happier person for it. I can’t imagine what it would be like to have all this sadness pent up inside. It used to be that way. It used to be I would go home and immediately start obsessing over my cases, freaking out over every detail, crying over the losses. But now I can sleep at night. I am healthier. And it makes me a better doctor and a better social worker. I used to think the social workers who were always formal with their patients weren’t the good ones. But now I realize they are the best.

Cristina Johnson

7/19/2016
St. James Hospital
Fort Wayne, Indiana

Jason Brown was born a fighter. He’s been a fighter since day 1 when he was confirmed to have the heart failure his dad passed down. He’s been in and out of hospitals for ten years now waiting for this day. This day is the most important day of his life. And I’m glad I got to share it with him. Today is the day I gave Jason a brand new heart. He got his heart. Been on the transplant list for five years and he got bumped up drastically about three months ago when he entered late-stage heart failure. And yesterday we got a call late at night that a new donor had come in...and Jason got the heart! So his mom and dad rushed him in, he was still sleeping on his mother’s shoulder in his monster pajamas, and we got him ready for the operation. This morning we completed it. Jason will be just fine.
Like I said, a fighter. He had no idea he was getting a new heart, and then he not only accepted the major surgery, but now his body seems to be accepting the heart as well. We had a bit of a scare in the operating room, when his heart wouldn’t start again, but we got him back and he is already looking healthier. His mother, Jane, is so relieved and his father is over the moon. I think they will sleep well for the first time in 10 years, when their little son was born. And I know how that feels.
Heart transplants are one of my favorite things in the whole world. But today, seeing the smile on Jason’s face when I told him he would be okay hit the very top of the list.

Joseph Velasquez

7~19~16
St. James

Heart transplants do not happen often here at St. James. We are not a large cardiothoracics center, and the truth is another hospital in Fort Wayne gets most of the cases because we do not have a primary cardiac “god” here. But that doesn’t mean Dr. V can’t flash a surprise surgery once in awhile. Which he did today. Here in this hospital, Joseph Velasquez is God. And lucky for Jason Brown, this god doesn’t back down from any type of surgery.
So he gave a ten year old boy a new heart. I think he suffered from a genetic condition, I’m not really sure. I usually only talk to families before the procedure to help them figure out if this is the surgery they really want. But Jason was out of options, he didn’t have a choice, so I never really spoke to his family. He went on the transplant list and UNOS was notified when he was five. I never had a full conversation with either the boy or the parents. I never looked into their files. And I missed the post-op checks. I had a brief conversation with the parents during the surgery to see if they needed anything, and then again after the surgery to see if their son needed anything, but they didn’t, so I closed their case. No work, no mess, no problem.
Joseph Velasquez pulled me aside today to ask if I was all right. When I said yes, he immediately attacked and yelled at me for missing the post op checks, and not caring about patients, and accusing me of not doing my job well. I stood there and listened and thought about how much I have changed. I thought about how and why I was so different from just a couple months ago. But really, it’s all right. I don’t mind. Because I know that in fact I AM a better doctor now.

Cristina Johnson

7/31/2016
St. James Hospital
Fort Wayne, Indiana

I’ve always hated putting bones back together. Bones just are not my idea of fun. They’re bones. Bones. Sticks and stones bones. But today I had a rather fun case. Bobby Smith. Two extremely common names, 1 hilarious guy. He and his wife used to work together at a stand up comedy cafe, and they still use their skills everywhere they go. We had a very long, good talk before his surgery. He came into the emergency room last night with a broken femur, in pretty bad shape, after trying to climb up a ladder. He’s 67 years old, so when he fell his bones took a very large hit. He needed it surgically repaired. So this morning, I patched him up and in a few days he’ll be ready to go. I think I will really like his morning check-ins. He never fails to make me laugh. His jokes are truly funny, and he knows all types of humor. Plus he and his wife laugh so hard together whenever any of them make even the slightest remark that may air on the side of humor. They’re a great couple.
I’m very glad his surgery went as well as it did. Not being a primary ortho guy, I try especially hard for those types of surgeries. I can’t really know how each surgery is going to work out until I am in there, standing over the patient. It is the most wonderful feeling in the world. You will never have a better high than standing in a room and knowing exactly what you are about to do to save a life. And even though a lot of the time something happens and you have a problem or you are stuck, you feel great. I love surgery. But I’m also starting to appreciate why. The people make it more fun. The patients make my day better, the nurses make me laugh. They call it coming out of a shell. I never had a shell. I just didn’t feel like talking to people. I wasn’t shy, I was hasty. I never really got to know them. But now I take the time to. And I have a lot more fun with my job.

Joseph Velasquez

7~31~16
St. James

The worst part of being less involved with patients is when they are the nicest people on the planet. Which is definitely what I had today, with Bobby and Cathy Smith. They are a very nice couple. Bobby, 67 years old, came in with a femur fracture. It was a bit of a scare for Cathy but she called her children and they came from all around the country to be with her. Tammy, who lives in Iowa. Cami, who lives in New York. Sammy, who lives in California. Pammi, who lives in Nebraska.  Sammy, Cami, Pammi and Tammy. Four girls who would NOT stop talking. They loved to talk. And when I met the parents, I understood.
Bobby and Cathy are comedians by trade. And I got to hear all of their jokes while I sat in a mini therapy session with Cathy. Since she was freaking out so much, I did have to spend several hours with her first before the surgery, then I sat with her for the entire surgery, and finally after, when he was in the recovery room before he woke up. By the time he woke up, the daughters had arrived and I met them and quickly excused myself. I could hear their laughter and cheers from the elevator, down the hall, on the next floor. What a family.

Cristina Johnson

8/11/16
St. James Hospital
Fort Wayne, Indiana

The ones you can’t save are always the hardest. And the ones you should have been able to save just add insult to injury. It was a simple craniotomy. Not planned, but a patient in the ER that needed one immediately. Hallie Drew, only 44 years old. She was in a car with her husband, Dan, going to a party. They had just left poor little Lizzie, a young babysitter, with their two little ones. And a drunk driver hit her. Dan got out without a scratch. But Hallie needed a craniotomy, a splenectomy, and exploratory surgery for a perfed bowel. I was the only surgeon on call tonight. I had to save this woman.
Hallie had a brain aneurysm. She was diagnosed a few months ago and was scheduled for surgery later this week. It wasn’t too severe, but in the accident it ruptured. I opened up her brain first. I started the craniotomy and she coded. I opened her up to access the spleen that was releasing free fluid in the abdomen. I was almost there when her brain started swelling beyond allowable measures. The nurses were trying to help but I was the only one in the room that could do all of it. I ran back to the head and worked a little more on my craniotomy, and when everything seemed under control I finished the splenectomy. I closed her back up and almost immediately she coded again. I was able to revive her and we performed an ultrasound on her bowels. Nothing seemed to urgent, so I continued. I went with clipping the aneurysm. It clotted. She went into v fib. I defibrillated. She coded. I resuscitated. By now one of the lesser surgeons I had paged had reached the hospital and scrubbed in. She stood there, not knowing what to do. I realized the bowel must have been causing the problems. I asked the surgeon, whose name I think is Dr. Arthur, to open her up. She did and found that the bowel was tearing apart. Dr. Arthur immediately tried to stop the tearing but it was too late. I had one nurse giving Hallie CPR, one pushing all sorts of fluids and meds, one hanging multiple units of blood, three assisting Dr. Arthur, Dr. Arthur herself, one monitoring every other organ, one trying to push his way in to get an ultrasound of her other organs, four trying to help me, and me trying to control the bleeding of her aneurysm.  She ended up coding four more times before I eventually was not able to bring her back.
In other words, it was a lost cause. Hallie Drew passed away. When I told her husband, he sank to the floor crying. Lizzie and the kids were there too. I can’t imagine what they must be going through. But for me it was traumatic and painful. She was going to be just fine. They were going to a dinner party, she had on a purple dress. It sparkled. She had silver heels. He was in a suit. But in three seconds, life turned 180 degrees for them. And all I could do was apologize.

Joseph Velasquez

8~11~16
St. James

Death for a long time has been considered the #1 fear of many people in this world. But there are always a few we meet that are not afraid of death. It doesn’t mean they welcome it. Some do, but that’s not necessarily what it means. People who aren’t afraid of spiders aren’t going to welcome one in their food. Anyway, a woman came in today who was not afraid to die. I never spoke with her, she was unconscious and tubed as she came in through the emergency room doors, but you could see it on the peaceful look on her seemingly sleeping face. She was not afraid to go to the light. Her husband was terrified of her dying. It seems that’s all he has been afraid of for quite some time now. I have been with Hallie and Dan for a very long time now. I have met with them, heard their tears and joys, and talked for hours in long sessions about their strange obsessions (Hallie wrote for a magazine about ducks, and Dan conducted science experiments to see how many ways one could use a plate.)
Hallie had a brain aneurysm. A big, fat, nice looking brain aneurysm that would not be harmful to her at all unless it ruptured, which in all 90% probability wouldn’t happen because she would have to hit her head with a force of over 2000 newtons to have that happen. But her car crashed, and she was gone. She was gone and she didn’t mind it so much. She didn’t mind that she was leaving her husband and two kids. I watched her final moments and wasn’t sad for her, because she wasn’t sad for herself. She never made it off the table, but I know. I know that laying there, she was prepared. She was okay. She was not afraid of untimely, painful, scary death. Dr. Velasquez did everything he possibly could. He felt the blow of this loss. I could tell. Her husband certainly did. Her kids didn’t quite understand, but her babysitter was at a loss. She gripped her purse very tightly and I watched her tanned hands turn white as they lost blood flow.
I have always marveled at people who are not afraid to die. What do they tell themselves? And am I afraid? I am not afraid in the sense that I am scared to walk out of the house because maybe I’ll spontaneously combust. But if I end up in surgery for a live saving operation, will I be okay with letting go? Will I be scared to die?
The kids and the husband will start seeing a full time therapist. I did my job for the night and took care of them for the mandated six hours after. Even called the therapist in. So I will put them out of my head before I drive home. And I will sleep okay tonight.

Cristina Johnson

9/5/2016
St. James Hospital
Fort Wayne, Indiana

Once when I was in high school I was pressured by my friends to try smoking once. I did it, just to try. I immediately spit it out. It was the grossest thing I’ve ever done. So now, whenever I see a smoker, I plug my nose, hold my breath, and try to walk at least 20 yards away. And today I had my hands inside the chest of a very heavy smoker.
Tyler Morrell is 82 years old. He’s smoked 5 packs a day since he was 12...he’s gone through more than 400 packs in his life. It’s a miracle he isn’t dead already. He’s in very late stage heart failure. But he asked for more chances so this time we gave him his final one: an LVAD. Left Ventricular Assist Device. Pumps the tired heart for you. Good for people on the transplant list. But we talked it over with Dr. Johnson and his family and he said, I remember very clearly, “Son, I’ve been smoking for 80 years now. I ain’t about to stop any time soon. Don’t give me a new heart. I’ll just ruin it. Give it to a young one that has a chance and will take care of it. I’ll try this LVAD thingy, but a transplant won’t do anyone any good.” He’s a tired man. His body has to do twice the work as a normal person from the strain of smoking. We all agreed it would be best. In fact his son Mark even told me, “My dad is done. He won’t try. He doesn’t want to. He only has a couple years left and he wants to spend them smoking in peace. I’ve fought for twenty years to get him to quit, and this is the final battle. Just give him the LVAD.” Mark’s wife Lisa held their baby, Tyler’s grandbaby, and nodded. So I took him to surgery and gave him the victory of his son’s final battle. He has an LVAD. He has a couple more years.
Even though Tyler is no longer a surgical patient, after he leaves, I’ve asked the family to check in with me. Just to see how he’s doing. They promised to call me when he starts slowing down and when he eventually passes. I thanked them and we had a very long conversation. It ended with the three adults, Mark, Lisa, and I leaving and getting a meal in the cafeteria. Tyler was still asleep. I feel terrible for that family. Ever since he found out smoking is bad for you, Mark has been trying so hard. Lisa tried really hard as well. She met Mark when she was 12, he was 14. They all fought. Mark’s mom, Michelle, passed away a couple years ago. She fought to get him to quit as well. But he wouldn’t listen or change.
I made something of an effort to talk to him. But he wouldn’t listen and eventually it was surprisingly Cristina who pulled me away and wouldn’t let me talk to him. She never made an effort to get him to quit either. I felt desperate. Why wouldn’t he listen to everyone around him? But I realize there is nothing I can do but give him this last chance. He is riding on his last chance.

Joseph Velasquez

9~5~16
St. James

Tyler Morrell has nothing. He has everything, to us, but to him, he has nothing. He has a young, strong son, a beautiful daughter in law, and a precious grandbaby. He lives in a rich house on the cornfields and rolling hills. He watches the sunrise every day. But he is here in the hospital and that means it’s been 3 days since he’s smoked a single cigarette. I almost feel sorry for him as I watch him lie there shivering. He desperately wants to smoke. And as soon as he gets out of here he’s going to. I can’t change that. His family can’t change that. And Dr. Velasquez certainly can’t change that, no matter how hard he tries. Which he did. He passed it off as something small, but he was practically yelling at the man. I had to order him out of the room and when he didn’t, I dragged him out forcefully and restrained him. I understand the frustration. For many patients I felt the exact same way. And I would get anxious and worried and upset and try so hard. But for some people there is absolutely nothing I could say that would change anything. A couple people I would be able to change. But I have started to learn my limits. There are quite a few. And my limits do not let me reach Tyler.

And I’m okay with that.

I’m working on being okay with that.

But that’s what it’s all about. Letting Tyler go destroys him, but it helps me tremendously. What is catastrophic for the fly is survival for the spider. And I am not a “predator,” I am a good doctor. I am a very good doctor. And I am an excellent social worker. And I know what I can and can’t do for my patients. So while not trying may sting a little, it ends up being better.
Tyler didn’t die today. He got a new chance. And that’s not bad for anyone.

Cristina Johnson

9/30/2016
St. James Hospital
Fort Wayne, Indiana

A very long time has passed since I have been praised for my empathy. I believe it is the first time since I’ve come here to St. James, and I’ve been here almost ten years. But today, as I held a mother’s  hand and stroked her kids’ hair, as they received the news that their son and brother was not coming home, I got a gentle compliment. Nicky Lancaster did not have the odds in his favor. 23 years old, pancreatic tumor with nowhere to move. Standing over him, I was lost. I didn’t know what to do. I couldn’t move from any angle. So eventually he bled out. Right there in front of me. I sat there and talked and explained and labored through my loss with his family. And after, it wasn’t elaborate, but Dr. Cristina Johnson came over, tapped me on the shoulder, and praised my empathy.
I am a better doctor.

Joseph Velasquez

9~30~16
St. James

Another death happened. But I let it wash over me. 23 year old Nicky Lancaster had a family. Let the family grieve, not me. Dr. Joseph Velasquez, probably the most awkward person in the hospital, was the best with them. I was with them. But not to the point that I might have been their family member. I was above the chaos. It felt like I was floating above everyone, looking down watching them. It was peaceful. I was okay.
I am a better doctor.

Cristina Johnson