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All Hail West Texas!

By Orlando Garner, MD

In 2002, the Mountain Goats, an American folk band led by John Darnielle, released an album titled All Hail West Texas. The first thing that struck me about the early years of the Mountain Goat’s records were how sparse they were, if this was stylistic choice or a means to an end, I do not know. It is well known that those early records produced by John Darnielle were recorded on a Panasonic RX-FT500 cassette tape recorder. The very last album he recorded in this way was about my current home, West Texas. In a lot of ways, the album resembles its namesake with its subdued melodies juxtaposed in a very plain, drawn out canvas the same way the West Texas sky colors, with its unique reddish hue and dispersed cotton candy clouds, the endless roads seasoned with scattered oil pumps throughout. This place is not for everyone, the same way the record is not. But when you see the beauty of infinity with an unraveling clear starlit sky and a sprawling desert that suddenly turns into mountains, it’s easy to understand why Darnielle sang about wanting these highways to be a Mobius strip that he could ride forever.

A Post-call West Texas Sunrise

West Texas is not only home to breathtaking sunsets but also to Texas Tech Health Sciences Center (TTUHSC), currently celebrating its 50th anniversary in their mission of bringing healthcare to the area. It has five campuses throughout the state, and I was fortunate enough to match in the Permian Basin campus. TTUHSC Permian Basin is in the city of Odessa, where you will see many multicolored jackrabbit statues adorning its surroundings and is 20 miles away from its sister city, Midland, curiously named the “Tall City”.

As I wake up for the morning grind with freshly brewed coffee from my home country, Honduras (best in the world) in my Hallmark coffee tumbler and see the dawn sky on my way to work, I feel very thankful for the people I have met here and the experiences I have garnered. My program taught me medicine in an unexpected way, it not only prepared me to care for people who are ill but also took the time to show me how to be more empathetic. It taught me not to judge people through the worst moments of their life; it taught me I wanted to be an intensivist.

First Day of Residency with the Hallmark Odessa Jackrabbit

If you have ever happened to glance at Carel Fabritius’ painting “The Goldfinch” you can probably dismiss it as a painting about a bird. Upon closer examination you would notice that the bird is chained alone to its perch, its plumage beautifully highlighted by the Dutch painter in striking yellow, contrasted with a heavy shadow casted by the subject. This juxtaposition between light and shadow is called chiaroscuro, a technique championed by Fabritius’ teacher Rembrandt van Rijn. As Fabritius progressed in his career, he ultimately favored light over dark. Little is known about why the artist painted this goldfinch, a bird known for its beauty and liveliness. This little goldfinch reminds me of patients in the ICU who had a full life before coming to the hospital or who at other moments of their life  were vibrant people but are now figuratively chained to their own private perch.

If Fabritius were to paint a scene of any ICU, I’m sure he would use a chiaroscuro technique to represent the everyday hustle and bustle of all involved. ICU is a game of light and shadow, one we see happen before our very own eyes. In one of my very first ICU rotations as a resident I recall a young man with five children who had a severe brain hemorrhage and I remember my attending speaking with this man’s wife as he told her that he got to the hospital too late, he would not recover. I will carry her stoic crying with me throughout my entire life. That very same day across the hall we had just successfully extubated a middle-aged woman who underwent a cardiac arrest due to a myocardial infarction likely precipitated by her rheumatoid arthritis. All her family hugged her very happily as she smiled radiantly at having survived this fatal condition. As the day dwindled my attending walked up to me and asked, “Do you still want to do critical care?” to which I replied “Yes, we helped that lady” and he nodded “Yes, yes we did help her.”

APDIM Chief Resident Conference
Presenting a Poster at the American Thoracic Society Conference

During residency I have learned that critical care allows you to focus on the medical and emotional part of our profession. It’s very easy to dehumanize somebody when they are connected to so many beeping machines, but I believe my mentors trained me to see the person behind the ventilator and become a more compassionate physician.

I have been exposed to the most interesting cases in my short spanning medical career, some of which I have been able to publish and present at international meetings. It allowed me to discover that I really enjoy writing case reports and to encourage others to do so, it showed me that I like teaching my underclassmen the ropes in the unit. These experiences have led me to become a strong believer in disseminating knowledge and inspired me to start a podcast with one of my fellow residents, to serve as a teacher for interns who were just like me: shaking in their boots.

Resident Retreat with our Program Director, Chairman, and Program Staff

As my days in West Texas come to an end, I reflect on all that has happened both in and out of residency. My family of two became a family of three with the addition of a beautiful Texas cowboy and I met peers and co-workers who are now my friends. I became chief resident, met Big Bird at the Wagner Noel, saw planet Mars in the McDonald observatory at Fort Davis, had a beer at the Big Bend Brewing Co. at Alpine, heard seminal punk band Wire at Marfa, went to the most unlikely Prada store in Valentine, presented at the regional ACP competition at Lubbock and cheered for Texas Tech when they reached the Elite Eight during March Madness.

Taking a page from Bilbo Baggins, a hobbit character from author J. R. R. Tolkien, I am ready for my next adventure as a critical care medicine fellow at Baylor College of Medicine in the largest medical center in the world, but in my heart of hearts, “All Hail West Texas!”