July Third Year:
I always knew my sister was a keeper. I idolized her from the start. There was the time when she slipped a diagram under our bedroom door, replete with a picture tutorial of how to escape my time-out via the bedroom windows. There was the time she let me ride bikes downtown with her to buy her latest pet and then let me take over care for said pet (hahaha!). There was the time she let me listen in to the recounting of her latest dating misadventures, even though I was only 12 but dying to be grown-up enough to hear . And there were the million other times she has screwed my head back on straight when I've started talking crazy. Growing up, I just wanted to be like her*. And now I just want to be with her, so it's a good thing we only live 20 minutes apart.
Yesterday we left our little ones in the capable hands of grandmas/nannies (with the exception of her nursing infant, who is so quiet, she doesn't really count) and headed out to Leesburg for the love of a good deal. We're both re-decorating right now, so we each had our wish list. And maybe it's the karma of sisters, but we both found just what we were looking for.
Somehow we managed to get it all into her mini-van (oh the wonder!):
We celebrated our spoils over lunch at Friday's. A sister knows that after you've both ordered your salads, and just as the server is walking away, it is the right thing to say, 'actually, can we get a side of fries with that?' Since I'd been thinking exactly the same thing, I added, 'with a side of ranch?' Perfection!
I could write a page long list about the things I love about my sister (beautiful! brilliant! spiritual! kind! funny! talented!), but as we talked, with the easiness and understanding that comes with a shared lifetime, blood and history, I realized that the heart of the matter is this:
God made sisters because He knew there would be things that only He and she could understand.
And I'm so grateful He gave me one. Cause Heaven knows I couldn't do it without her
Tuesday, November 2, 2010
Archives: Winding Down
April Third Year:
I can tell that the end of my official medicine training road is drawing near.
Nostalgia has always been my go-to emotion...never very far from the surface. Lately, though, it comes in more noticeable and frequent waves.
Last night, for example: I was the back-up call resident. In the last few months of residency, that is usually a blessed thing where you review ER patient's with the 2nd year resident on the phone but stay home unless someone is sick, sick, sick. It almost feels (oh happy day) like not being on call at all. Still, I had never made plans to do anything on a call night. You know how the cosmos can be.
This week I couldn't resist an invitation to join some of our friends for dinner at their home. I joked to Rockstar, "surely this will mean that things won't go as planned."
We walked into their lovely home, and immediately my cell phone went off. It was the 2nd year resident. She had two patient's to admit at one hospital and another waiting at the other hospital. The pager was exploding. She was freaking out. "I have never asked for help, but I am drowning...could you answer the phones for me?" Ha! Told you so. After thirty minutes spent trying to figure out why the pager system was malfunctioning, I was able to log in and start covering the messages for her.
My gracious host never batted an eye as I darted in and out of the dining room, and turned their lovely dinner party into a harried scene. The food, by the way, was divine.
As we were leaving their house, I checked in with the 2nd year again and discovered that 2 or 3 more admissions had come in to the hospital she was at. Panic was evident in her voice and her mind was showing signs of being lost entirely. I've had nights like that. I felt for her. "Just breathe, we'll get through this. I've got the phones covered. After I put the baby down, I'll head to the other hospital and take care of that admission." Palpable relief rushed through my earpiece as she sighed, "Thank you. so. much."
I got to the hospital late, during that hour when the ER is still crazy, but the rest of the halls are quiet. I actually love the hospital during that time. It is quiet, sacred and feels strangely like home. I should've known I'd end up as a doctor when hospitals ranked up with bookstores, libraries and The Disney Store as enjoyable places during my childhood.
I don't spend as much time at this particular hospital anymore. I'm there on occasion, but spend more time at another local hospital. It felt good to be back. Walking down a deserted hallway with only the clack of my shoes to fill the space, scenes from my time here popped up like TV episodes in my mind: surgeries assisted on, residents worked with, patients cared for. Emotions came rushing back: grumpy over-tiredeness, satisfaction, desperation, relief.
I should not feel nostalgic over thirty hour shifts, 80+ hour work weeks, and days that make you feel like your emotional, intellectual and physical reserves are being taxed completely. But somehow I do.
I walked down a corridor between the main hospital and the heart center. My white coat hung on my shoulders in the comfortable way that it has ever since it stopped feeling like a costume a few years ago. I smiled at the few families who were still in waiting rooms. They smiled back with that smile imbued with subtle gratitude. 'Thank you for being here and taking care of patients', it seems to say.
I found my patient. "Hi, I'm Dr. *," I began. Like so many times before. I finished up my work and then retraced my steps back to my car.
Why the nostalgia? I feel nostalgic over things that I know I'll never get back or experience in quite the same way again. I feel nostalgic over things that have meaning, over things that I'm grateful for and over things that have shaped my person. And becoming a doctor has done nothing if not shaped me into something new, and hopefully, better.
I feel nostalgic because my training reminds me how much joy is found in unexpected places, including at the end of any given rope. I feel nostalgic because the hard was worth the good, and I would never have guessed that. I feel nostalgic because I've built relationships that can only be built in the trenches. And I'll miss that bonding but not the fire. The fruits but not the labor. I'm grateful that it's done--that I did it--yet sad to see it go. Make sense? Still sorting through it, as you can probably tell.
All I really know is that I'm nearing a very big milestone, and it will be interesting to see where the road goes next.
Thanks for coming along for the ride. :)
I can tell that the end of my official medicine training road is drawing near.
Nostalgia has always been my go-to emotion...never very far from the surface. Lately, though, it comes in more noticeable and frequent waves.
Last night, for example: I was the back-up call resident. In the last few months of residency, that is usually a blessed thing where you review ER patient's with the 2nd year resident on the phone but stay home unless someone is sick, sick, sick. It almost feels (oh happy day) like not being on call at all. Still, I had never made plans to do anything on a call night. You know how the cosmos can be.
This week I couldn't resist an invitation to join some of our friends for dinner at their home. I joked to Rockstar, "surely this will mean that things won't go as planned."
We walked into their lovely home, and immediately my cell phone went off. It was the 2nd year resident. She had two patient's to admit at one hospital and another waiting at the other hospital. The pager was exploding. She was freaking out. "I have never asked for help, but I am drowning...could you answer the phones for me?" Ha! Told you so. After thirty minutes spent trying to figure out why the pager system was malfunctioning, I was able to log in and start covering the messages for her.
My gracious host never batted an eye as I darted in and out of the dining room, and turned their lovely dinner party into a harried scene. The food, by the way, was divine.
As we were leaving their house, I checked in with the 2nd year again and discovered that 2 or 3 more admissions had come in to the hospital she was at. Panic was evident in her voice and her mind was showing signs of being lost entirely. I've had nights like that. I felt for her. "Just breathe, we'll get through this. I've got the phones covered. After I put the baby down, I'll head to the other hospital and take care of that admission." Palpable relief rushed through my earpiece as she sighed, "Thank you. so. much."
I got to the hospital late, during that hour when the ER is still crazy, but the rest of the halls are quiet. I actually love the hospital during that time. It is quiet, sacred and feels strangely like home. I should've known I'd end up as a doctor when hospitals ranked up with bookstores, libraries and The Disney Store as enjoyable places during my childhood.
I don't spend as much time at this particular hospital anymore. I'm there on occasion, but spend more time at another local hospital. It felt good to be back. Walking down a deserted hallway with only the clack of my shoes to fill the space, scenes from my time here popped up like TV episodes in my mind: surgeries assisted on, residents worked with, patients cared for. Emotions came rushing back: grumpy over-tiredeness, satisfaction, desperation, relief.
I should not feel nostalgic over thirty hour shifts, 80+ hour work weeks, and days that make you feel like your emotional, intellectual and physical reserves are being taxed completely. But somehow I do.
I walked down a corridor between the main hospital and the heart center. My white coat hung on my shoulders in the comfortable way that it has ever since it stopped feeling like a costume a few years ago. I smiled at the few families who were still in waiting rooms. They smiled back with that smile imbued with subtle gratitude. 'Thank you for being here and taking care of patients', it seems to say.
I found my patient. "Hi, I'm Dr. *," I began. Like so many times before. I finished up my work and then retraced my steps back to my car.
Why the nostalgia? I feel nostalgic over things that I know I'll never get back or experience in quite the same way again. I feel nostalgic over things that have meaning, over things that I'm grateful for and over things that have shaped my person. And becoming a doctor has done nothing if not shaped me into something new, and hopefully, better.
I feel nostalgic because my training reminds me how much joy is found in unexpected places, including at the end of any given rope. I feel nostalgic because the hard was worth the good, and I would never have guessed that. I feel nostalgic because I've built relationships that can only be built in the trenches. And I'll miss that bonding but not the fire. The fruits but not the labor. I'm grateful that it's done--that I did it--yet sad to see it go. Make sense? Still sorting through it, as you can probably tell.
All I really know is that I'm nearing a very big milestone, and it will be interesting to see where the road goes next.
Thanks for coming along for the ride. :)
Archives: Pockets
June Third Year:
I know I've been quiet on here lately. With multiple major life transitions all converging on the month of June, I just gave myself permission to totally slack. In this respect, anyway.
It turns out that there are a myriad of i's to dot and t's to cross as residency comes to a close.
And it turns out that moving into a house (that we own!) takes a considerable amount of time and planning.
And it turns out that taking your last set of boards takes some effort.
And it turns out that I can still find time for 'So You Think You Can Dance.' Ha!
And with all the madness, I've been waiting for my thoughts to coalesce and make sense. Usually, I go about my day with thoughts swirling around. Suddenly, they come together in a flash-bang kind of way, and I go write them down. It hasn't happened recently.
So, yeah. I've been quiet.
But then the juices have started flowing as I've been sifting through the pieces of my life in the packing process. Oh the nostalgia!
Last night I finally decided to conquer my medical bags. Over the last several years, I have basically lived out of the pockets of my white coat. Trinkets, books, paper, drug company paraphanelia all weighed me down as I walked the halls of my hospitals. And every time I washed my coat, I would empty my pockets into a safeway bag. And when I put it all back, I usually selected only the important items to go back in. Which meant that I had scads of bags full of old medical junk/treasures. And I couldn't quite throw it all away. So I ended up with something like this:
And sorting through it proved an interesting walk down my medical lane.
I found this:
My very first pager from med school. It looks so old school, now, seeing as it is not a text pager. But it was my first one...the one which seemed impossibly cool at first blush...only to seem impossibly unbearable a thousand midnight interruptions later. It woke me up for transplants and sick babies and ER admissions. It introduced me to medical life. It sat on my hip through my first two years of life-changing, oft-terrifying, humbling hospital training. And now it sits unceremoniously among trinkets, like it never did anything very important at all. Dear Pager: I won't ever forget you.
And I found this:
I could still have free lunch at a hospital! But the thought of eating the same foods I lived on as an intern, appeals to me less than free food. And that's saying something.
This:
Cause even tired doctor's need sassy lipgloss?
And a way to make sure there's no lettuce in your teeth? Heaven knows every other bit of vanity goes straight out the window.
This:
My on-call notes. I have so many of these pages! Sometime illegible scrawlings with phone numbers to call back, symptoms to evaluate, and sometimes angry remarks at the unfairness of the on-call universe. This is practically my journal! My record of my labor! How do I throw this all away? (Don't worry, Mom, I did.)
This:
Parking passes for garages I'll never visit again.
This:
A list of vital signs looked up for our census of patient's during my surgical 'Acting Internship.' These were hard-won vitals signs, as I had to arise at 4-something to gather them. Isn't that worth something? This piece of paper is not a piece of paper. It is a badge of honor
This:
My notebooks of 'beginners pearls'. Little notes about important things I might want to remember. Tips from those who'd gone before. My first attempts to keep track of the seemingly endless line of facts to be learned. I think I'll want these when I'm 90.
This:
Cards of questions I'd written down...things to look up at a later date. And how amazing! I know all these answers now. In fact, they seem like second nature. So I think: I guess I'm really a doctor. Those index cards show me how far I've come.
And finally, this:
Okay, so she wasn't in a Safeway bag, but how lucky am I to have picked up this treasure during my medical training? I never dreamed I'd graduate Residency with the most joyful little girl at my side. And it was the greatest gift of all.
So here we are.
11 days from the end.
11 day from the beginning.
I know I've been quiet on here lately. With multiple major life transitions all converging on the month of June, I just gave myself permission to totally slack. In this respect, anyway.
It turns out that there are a myriad of i's to dot and t's to cross as residency comes to a close.
And it turns out that moving into a house (that we own!) takes a considerable amount of time and planning.
And it turns out that taking your last set of boards takes some effort.
And it turns out that I can still find time for 'So You Think You Can Dance.' Ha!
And with all the madness, I've been waiting for my thoughts to coalesce and make sense. Usually, I go about my day with thoughts swirling around. Suddenly, they come together in a flash-bang kind of way, and I go write them down. It hasn't happened recently.
So, yeah. I've been quiet.
But then the juices have started flowing as I've been sifting through the pieces of my life in the packing process. Oh the nostalgia!
Last night I finally decided to conquer my medical bags. Over the last several years, I have basically lived out of the pockets of my white coat. Trinkets, books, paper, drug company paraphanelia all weighed me down as I walked the halls of my hospitals. And every time I washed my coat, I would empty my pockets into a safeway bag. And when I put it all back, I usually selected only the important items to go back in. Which meant that I had scads of bags full of old medical junk/treasures. And I couldn't quite throw it all away. So I ended up with something like this:
And sorting through it proved an interesting walk down my medical lane.
I found this:
My very first pager from med school. It looks so old school, now, seeing as it is not a text pager. But it was my first one...the one which seemed impossibly cool at first blush...only to seem impossibly unbearable a thousand midnight interruptions later. It woke me up for transplants and sick babies and ER admissions. It introduced me to medical life. It sat on my hip through my first two years of life-changing, oft-terrifying, humbling hospital training. And now it sits unceremoniously among trinkets, like it never did anything very important at all. Dear Pager: I won't ever forget you.
And I found this:
I could still have free lunch at a hospital! But the thought of eating the same foods I lived on as an intern, appeals to me less than free food. And that's saying something.
This:
Cause even tired doctor's need sassy lipgloss?
And a way to make sure there's no lettuce in your teeth? Heaven knows every other bit of vanity goes straight out the window.
This:
My on-call notes. I have so many of these pages! Sometime illegible scrawlings with phone numbers to call back, symptoms to evaluate, and sometimes angry remarks at the unfairness of the on-call universe. This is practically my journal! My record of my labor! How do I throw this all away? (Don't worry, Mom, I did.)
This:
Parking passes for garages I'll never visit again.
This:
A list of vital signs looked up for our census of patient's during my surgical 'Acting Internship.' These were hard-won vitals signs, as I had to arise at 4-something to gather them. Isn't that worth something? This piece of paper is not a piece of paper. It is a badge of honor
This:
My notebooks of 'beginners pearls'. Little notes about important things I might want to remember. Tips from those who'd gone before. My first attempts to keep track of the seemingly endless line of facts to be learned. I think I'll want these when I'm 90.
This:
Cards of questions I'd written down...things to look up at a later date. And how amazing! I know all these answers now. In fact, they seem like second nature. So I think: I guess I'm really a doctor. Those index cards show me how far I've come.
And finally, this:
Okay, so she wasn't in a Safeway bag, but how lucky am I to have picked up this treasure during my medical training? I never dreamed I'd graduate Residency with the most joyful little girl at my side. And it was the greatest gift of all.
So here we are.
11 days from the end.
11 day from the beginning.
For Better or Worse
March Third Year:
I was on call last week during the snowstorm. We always work the afternoon/evening acute care clinic when we're on call, and, ostensibly because of the bad weather, the schedule was mercifully light. However, as we were preparing to pack-up, a mom and her 6 year old son (we'll call him Joe) walked into the office hoping to be seen. Joe had been snowboarding when his right under-eye area wound up on the wrong end of an encounter with a board edge. The half-moon gash wasn't deep but was wide enough to leave a permanent scar. Mom brought him in to find out if he needed stitches. Joe was terrified of this possibility.
I took a look and delivered the bad news, "There is going to be a much smaller scar if I put a few stitches in there to hold it together." Joe started crying. Mom looked distressed.
"Oh," she said, "I was hoping it wouldn't come to that. But I guess we'll do what we have to do." Her son was quivering at her side.
"I'll be right back after I get together my supplies."
Before I walked back in, my attending suggested I bring in the papoose, 'just in case'. The papoose is, um, sort of what it sounds like. You strap a kid to a backboard, and it allows you to do things (like stitch up their faces) that any self-respecting 6 year would normally kick/scream/yell/thrash around to keep you from doing.
I entered the room and set up my supplies. Mom picked up her purse. "I'll be in the waiting room."
And then she bailed.
?????
I was flabbergasted. Her terrified son was sitting on the exam table, looking at me like I was the firing squad. And he was alone. Now I had to be mommy and doctor. I sat next to him and smoothed his hair while he cried. "It's going to be okay, Joe. I promise you. The numbing medicine is going to sting a little, but then you won't feel anything."
I spent the next 30 minutes in a song and dance routine with Joe. I'd get close to his face with my needle. He'd bravely say it was okay. My needle got closer. He suddenly darted away. I'd comfort him. He'd say, 'okay, try again'. He'd change his mind. Tears kept flowing. I'd say 'maybe I should get out the papoose.' He'd somehow get brave again. Finally, the numbing medicine was in. And even though he was through with the worst, we went through the routine all over again when it came to sewing his wound closed. There was just the nurse and I during this time: comforting, talking, doctoring though we'd only known Joe for a matter of minutes.
I was so relieved when the stitches were finally in. I went and got mom. She also seemed relieved. She kept hugging her son and saying, "I need a hug!" And I'm thinking, 'Lady, your son needs the hug. You need something else entirely.'
In talking to my colleagues afterwards, I expressed dismay that she would leave her son alone during such a traumatic experience. My attending said, "Well, maybe she knew she would faint or something." Like it was no big deal.
But it is a big deal. I mean, I realize that sometimes we want parents out of the room. When we do spinal taps on babies, for example. It's easier for everyone. A baby has no idea what's going on and often looks at the parent with betrayal. "How could you let them do this to me?!"
Joe was not a baby. He was a 6 year old, fully aware of what he was about to experience. He, at such a young age, had to pull it together and get through a difficult experience. But his mom didn't? What message does that send to the child? "This is going to be so bad that I can't watch. But good luck with that!"
I don't know. I guess I just feel like it's part of the job description. As a parent, you have to be there for your kid when the going gets tough. You have to force yourself to do uncomfortable things. I had stitches when I was 12. My dad was there with me and it made all the difference. I remember burying my head into his shoulder and clenching his hand until it was through. I can't even imagine what it would have felt like if he'd bailed on me.
So, I pose the question to you dear readers: is it okay what that mom did? Is it okay to leave a child alone for a difficult procedure (and let's leave babies out, since I do think that's different)?
I think you know where I stand. ;)
I was on call last week during the snowstorm. We always work the afternoon/evening acute care clinic when we're on call, and, ostensibly because of the bad weather, the schedule was mercifully light. However, as we were preparing to pack-up, a mom and her 6 year old son (we'll call him Joe) walked into the office hoping to be seen. Joe had been snowboarding when his right under-eye area wound up on the wrong end of an encounter with a board edge. The half-moon gash wasn't deep but was wide enough to leave a permanent scar. Mom brought him in to find out if he needed stitches. Joe was terrified of this possibility.
I took a look and delivered the bad news, "There is going to be a much smaller scar if I put a few stitches in there to hold it together." Joe started crying. Mom looked distressed.
"Oh," she said, "I was hoping it wouldn't come to that. But I guess we'll do what we have to do." Her son was quivering at her side.
"I'll be right back after I get together my supplies."
Before I walked back in, my attending suggested I bring in the papoose, 'just in case'. The papoose is, um, sort of what it sounds like. You strap a kid to a backboard, and it allows you to do things (like stitch up their faces) that any self-respecting 6 year would normally kick/scream/yell/thrash around to keep you from doing.
I entered the room and set up my supplies. Mom picked up her purse. "I'll be in the waiting room."
And then she bailed.
?????
I was flabbergasted. Her terrified son was sitting on the exam table, looking at me like I was the firing squad. And he was alone. Now I had to be mommy and doctor. I sat next to him and smoothed his hair while he cried. "It's going to be okay, Joe. I promise you. The numbing medicine is going to sting a little, but then you won't feel anything."
I spent the next 30 minutes in a song and dance routine with Joe. I'd get close to his face with my needle. He'd bravely say it was okay. My needle got closer. He suddenly darted away. I'd comfort him. He'd say, 'okay, try again'. He'd change his mind. Tears kept flowing. I'd say 'maybe I should get out the papoose.' He'd somehow get brave again. Finally, the numbing medicine was in. And even though he was through with the worst, we went through the routine all over again when it came to sewing his wound closed. There was just the nurse and I during this time: comforting, talking, doctoring though we'd only known Joe for a matter of minutes.
I was so relieved when the stitches were finally in. I went and got mom. She also seemed relieved. She kept hugging her son and saying, "I need a hug!" And I'm thinking, 'Lady, your son needs the hug. You need something else entirely.'
In talking to my colleagues afterwards, I expressed dismay that she would leave her son alone during such a traumatic experience. My attending said, "Well, maybe she knew she would faint or something." Like it was no big deal.
But it is a big deal. I mean, I realize that sometimes we want parents out of the room. When we do spinal taps on babies, for example. It's easier for everyone. A baby has no idea what's going on and often looks at the parent with betrayal. "How could you let them do this to me?!"
Joe was not a baby. He was a 6 year old, fully aware of what he was about to experience. He, at such a young age, had to pull it together and get through a difficult experience. But his mom didn't? What message does that send to the child? "This is going to be so bad that I can't watch. But good luck with that!"
I don't know. I guess I just feel like it's part of the job description. As a parent, you have to be there for your kid when the going gets tough. You have to force yourself to do uncomfortable things. I had stitches when I was 12. My dad was there with me and it made all the difference. I remember burying my head into his shoulder and clenching his hand until it was through. I can't even imagine what it would have felt like if he'd bailed on me.
So, I pose the question to you dear readers: is it okay what that mom did? Is it okay to leave a child alone for a difficult procedure (and let's leave babies out, since I do think that's different)?
I think you know where I stand. ;)
Archives: The Boy Who Cried Wolf
February Third Year:
Among our practice, there are a group of patient's who we refer to as frequent fliers. They are folks who wind up in the ER on such a regular basis, that we all know them well. Some, unfortunately, have medical problems that are resistant to outpatient control. Despite their best efforts and ours, they just keep bouncing back.
Then there are the GOMERS. Aptly named by the book "House of God", a GOMER is a 'get out of my ER'. It doesn't sound very charitable, but believe me.
These are patient's who mix in a lot of crazy with a little bit of illness and know how to work the system. They usually come in with the same complaints that can't be objectively proven and are often attached to some secondary gain. When the ER calls us to say that 'miss cyclical vomiting syndrome' is back again, there is much eye rolling to be had. If anyone had ever seen her vomit, or had evidence that she was in need of anything except more narcotics, there wouldn't be such a reaction.
But I got to thinking today: It's a dangerous game, this letting ourselves roll our eyes at the patient's we've come to expect melodramatic reporting from.
I got a call on a patient of mine who was back in the ER with the same pain complaints she has always had. The ER is so tired of her coming in for this, that they barely even initiate a work-up before giving her massive doses of pain meds. I walked in to her room with a pre-conceived notion of what she would say and need. And, for the most part, I was right.
Except there was one new symptom that she brought up. Could be part of her previous syndrome, I thought. Could be something new. I stopped. 'What would I do if I'd never met her before? What would I order if I had no idea her history of coming back again and again with these symptoms?"
It changed my management. I'm not sure if anything will come of it, but it was a humbling moment. Usually continuity is the thing that makes good medicine tick. But every once in a while, the past only obscures our view of the present.
In our friendships, in our work relationships, in our families, we've all come to expect certain things from certain people. But sometimes, we need to let that go. We need to believe that people innately have the ability to surprise us, and leave our doors open to be receptive to that.
Because at some point, we're all going to be the one asking for belief and a chance. And we all deserve to be heard.
Among our practice, there are a group of patient's who we refer to as frequent fliers. They are folks who wind up in the ER on such a regular basis, that we all know them well. Some, unfortunately, have medical problems that are resistant to outpatient control. Despite their best efforts and ours, they just keep bouncing back.
Then there are the GOMERS. Aptly named by the book "House of God", a GOMER is a 'get out of my ER'. It doesn't sound very charitable, but believe me.
These are patient's who mix in a lot of crazy with a little bit of illness and know how to work the system. They usually come in with the same complaints that can't be objectively proven and are often attached to some secondary gain. When the ER calls us to say that 'miss cyclical vomiting syndrome' is back again, there is much eye rolling to be had. If anyone had ever seen her vomit, or had evidence that she was in need of anything except more narcotics, there wouldn't be such a reaction.
But I got to thinking today: It's a dangerous game, this letting ourselves roll our eyes at the patient's we've come to expect melodramatic reporting from.
I got a call on a patient of mine who was back in the ER with the same pain complaints she has always had. The ER is so tired of her coming in for this, that they barely even initiate a work-up before giving her massive doses of pain meds. I walked in to her room with a pre-conceived notion of what she would say and need. And, for the most part, I was right.
Except there was one new symptom that she brought up. Could be part of her previous syndrome, I thought. Could be something new. I stopped. 'What would I do if I'd never met her before? What would I order if I had no idea her history of coming back again and again with these symptoms?"
It changed my management. I'm not sure if anything will come of it, but it was a humbling moment. Usually continuity is the thing that makes good medicine tick. But every once in a while, the past only obscures our view of the present.
In our friendships, in our work relationships, in our families, we've all come to expect certain things from certain people. But sometimes, we need to let that go. We need to believe that people innately have the ability to surprise us, and leave our doors open to be receptive to that.
Because at some point, we're all going to be the one asking for belief and a chance. And we all deserve to be heard.
Archives: Listen
January Third Year:
It's taken me a while to write this:
Sometimes the way God can align my life's little stars amazes me.
I mentioned a while ago that I'd had to tell one of my patients that he had lung cancer. It was so. hard.
But, as it turns out, what comes after a terminal diagnosis is infinitely harder.
J (alias) was stoic, but his wife needed my hand for holding. I was happy to offer up what little effective medicine I had.
The brevity of the time from diagnosis to near-death astonished me. The chemo, done in an effort to stave off the metastatic disease for a month or two at most, had destroyed most of his normal organ function as well.
Finally, the family decided, it was time for hospice care. If nothing else, they wanted to see his pain relieved. They settled into a strange new--albeit surely shortlived--normal and prayed that J would somehow make it to meet his first grandbaby. I prayed too.
They were often close to my thoughts.
Except not at 1 o'clock in the morning, which is what time it was when I finished up an admission during a brutal call night. I grabbed my coat and headed for the door. I still had to drive over to the other hospital we cover and admit another patient. These nights have taught me to just put my head down and keep moving.
Before I left, I checked the online ER charting system to see if any other patients of ours were in the ER. Our practice wasn't listed in the PCP (primary care physician) column for any other patient's. Phew. 'Maybe you should just ask the ER doctor's if they know of any patient's who might need to be seen." 'No, no,' I thought back, 'I just need to go get started on the next one. No one's listed in the computer anyhow.' But the thought persisted, as the good ones are so prone to do, and so I relented.
I stopped by the doctor station. "Anyone have a patient of ours pending?"
"Uh, yeah, actually I do," one doctor piped up.
NOOOO, I thought. Why, oh, why did I ask? There's always this fear that if you ask, the ER doctors will ask you to see and/or admit someone they otherwise would have sent home.
"Really? There's no one listed in the computer."
"Yeah, actually, I think he's your patient. You know J, right?"
"J's here??"
"Yeah, I wasn't going to call you until later, but since you asked. He is having some difficulty breathing. I know he's on hospice care, but his wife got scared. If you want to talk to them..."
"Yes, yes, of course. Thank you for letting me know."
What a strange coincidence, I thought.
I went into their room. "Dr. *!" They were relieved to see a familiar face. The wife's face was lined with panic and J's face was lined with fatigue. The work of breathing was taking a toll. He looked very sick, but was still awake, alert, talking. I examined him. Let's keep him overnight, we decided. Yes he was supposed to be on home hospice, but the staff wasn't being as attentive as they should have. I stepped out of the room so that I could write up his orders. I was tucked away in a little cubby working on them when I heard someone start wailing. Yikes, someone really sick must have just come in. I kept working.
Suddenly, a frantic nurse poked her head around the corner. "Your patient is dying out here!" she barked.
"What?!" My papers spilled to the floor as I stood up and raced toward their room. I could see the wife. Wailing.
I walked in, trying to offer up some calm in a tempest. I assessed the situation. J was staring straight ahead, not seeing, not responding. Not looking very 'with us.'
"Is he dead, Dr. *? Is he breathing? Is he BREATHING?". The rise and fall of his chest, and a heartbeat on the monitor, let me know that he was still, on some level, alive.
"Yes, he's still alive." More questions, more answers. I mainly tried to defray the fear.
We put an oxygen mask on, we gave him pain medicine, and then we waited. He was a DNR (do not resuscitate) so we did not do more.
The wailing softened into crying and expressions of love. It became clear that these were his final hours. They passed. His oxygen level began to drop. His breathing slowed.
"Can he still hear me Dr. *?"
What do you do when you don't have all the answers? "Yes, he can hear you."
Family and friends filled the small ER room. I held J's hand. I thought of what a good man he was and how well he had endured this illness. I thought of all the people who were in this room, and of all those who loved him. It was time to say goodbye.
After the final breath was taken, they looked at me. I went through the technicalities required to 'pronounce' someone.
"He's gone."
And it was back to wailing as the finality of it all settled in. Followed again by peaceful mourning. I wondered what to do next. There were technicalities to be dealt with, but they seem so out of place in these situations. Somehow we worked them out. We sat quietly and we hugged. Then I finally excused myself to go admit the patient at the other hospital.
"I can't believe you happened to be here tonight," the wife said before I left.
I know. I know. They usually go to the other hospital. I'm one of several doctors who share call. If I hadn't asked...If I hadn't listened to a thought....The ER doctor surely wouldn't have called me until it was too late.
She said she'd call me with the funeral information, and then I left.
I arrived home during the early hours of the morning. Almost daybreak. I slipped my key silently into the lock and let myself in. I didn't want to wake my baby or my husband, though I wanted desperately to hold them. I walked to the guestroom and fell to my knees.
'Heavenly Father,' I prayed. And then I talked to Him about what was in my heart. About the equal parts of depression, gratitude and astonishment that were filling up inside of me. About the meaning of life and suffering and death. About how grateful I was to Him for paying attention: to one small doctor on call and to one of a million families who was suffering. For putting us at the same hospital at the same time at the same hour on a Saturday night. About miracles and healing and my small part in those things. And about my understanding of eternity, and more importantly, eternal families.
I put my pager on the nightstand. My white coat lay crumpled next to the bed with my stethoscope inside.
Then I laid my head on my pillow, and I waited.
Sleep never came, but peace finally did.
It's taken me a while to write this:
Sometimes the way God can align my life's little stars amazes me.
I mentioned a while ago that I'd had to tell one of my patients that he had lung cancer. It was so. hard.
But, as it turns out, what comes after a terminal diagnosis is infinitely harder.
J (alias) was stoic, but his wife needed my hand for holding. I was happy to offer up what little effective medicine I had.
The brevity of the time from diagnosis to near-death astonished me. The chemo, done in an effort to stave off the metastatic disease for a month or two at most, had destroyed most of his normal organ function as well.
Finally, the family decided, it was time for hospice care. If nothing else, they wanted to see his pain relieved. They settled into a strange new--albeit surely shortlived--normal and prayed that J would somehow make it to meet his first grandbaby. I prayed too.
They were often close to my thoughts.
Except not at 1 o'clock in the morning, which is what time it was when I finished up an admission during a brutal call night. I grabbed my coat and headed for the door. I still had to drive over to the other hospital we cover and admit another patient. These nights have taught me to just put my head down and keep moving.
Before I left, I checked the online ER charting system to see if any other patients of ours were in the ER. Our practice wasn't listed in the PCP (primary care physician) column for any other patient's. Phew. 'Maybe you should just ask the ER doctor's if they know of any patient's who might need to be seen." 'No, no,' I thought back, 'I just need to go get started on the next one. No one's listed in the computer anyhow.' But the thought persisted, as the good ones are so prone to do, and so I relented.
I stopped by the doctor station. "Anyone have a patient of ours pending?"
"Uh, yeah, actually I do," one doctor piped up.
NOOOO, I thought. Why, oh, why did I ask? There's always this fear that if you ask, the ER doctors will ask you to see and/or admit someone they otherwise would have sent home.
"Really? There's no one listed in the computer."
"Yeah, actually, I think he's your patient. You know J, right?"
"J's here??"
"Yeah, I wasn't going to call you until later, but since you asked. He is having some difficulty breathing. I know he's on hospice care, but his wife got scared. If you want to talk to them..."
"Yes, yes, of course. Thank you for letting me know."
What a strange coincidence, I thought.
I went into their room. "Dr. *!" They were relieved to see a familiar face. The wife's face was lined with panic and J's face was lined with fatigue. The work of breathing was taking a toll. He looked very sick, but was still awake, alert, talking. I examined him. Let's keep him overnight, we decided. Yes he was supposed to be on home hospice, but the staff wasn't being as attentive as they should have. I stepped out of the room so that I could write up his orders. I was tucked away in a little cubby working on them when I heard someone start wailing. Yikes, someone really sick must have just come in. I kept working.
Suddenly, a frantic nurse poked her head around the corner. "Your patient is dying out here!" she barked.
"What?!" My papers spilled to the floor as I stood up and raced toward their room. I could see the wife. Wailing.
I walked in, trying to offer up some calm in a tempest. I assessed the situation. J was staring straight ahead, not seeing, not responding. Not looking very 'with us.'
"Is he dead, Dr. *? Is he breathing? Is he BREATHING?". The rise and fall of his chest, and a heartbeat on the monitor, let me know that he was still, on some level, alive.
"Yes, he's still alive." More questions, more answers. I mainly tried to defray the fear.
We put an oxygen mask on, we gave him pain medicine, and then we waited. He was a DNR (do not resuscitate) so we did not do more.
The wailing softened into crying and expressions of love. It became clear that these were his final hours. They passed. His oxygen level began to drop. His breathing slowed.
"Can he still hear me Dr. *?"
What do you do when you don't have all the answers? "Yes, he can hear you."
Family and friends filled the small ER room. I held J's hand. I thought of what a good man he was and how well he had endured this illness. I thought of all the people who were in this room, and of all those who loved him. It was time to say goodbye.
After the final breath was taken, they looked at me. I went through the technicalities required to 'pronounce' someone.
"He's gone."
And it was back to wailing as the finality of it all settled in. Followed again by peaceful mourning. I wondered what to do next. There were technicalities to be dealt with, but they seem so out of place in these situations. Somehow we worked them out. We sat quietly and we hugged. Then I finally excused myself to go admit the patient at the other hospital.
"I can't believe you happened to be here tonight," the wife said before I left.
I know. I know. They usually go to the other hospital. I'm one of several doctors who share call. If I hadn't asked...If I hadn't listened to a thought....The ER doctor surely wouldn't have called me until it was too late.
She said she'd call me with the funeral information, and then I left.
I arrived home during the early hours of the morning. Almost daybreak. I slipped my key silently into the lock and let myself in. I didn't want to wake my baby or my husband, though I wanted desperately to hold them. I walked to the guestroom and fell to my knees.
'Heavenly Father,' I prayed. And then I talked to Him about what was in my heart. About the equal parts of depression, gratitude and astonishment that were filling up inside of me. About the meaning of life and suffering and death. About how grateful I was to Him for paying attention: to one small doctor on call and to one of a million families who was suffering. For putting us at the same hospital at the same time at the same hour on a Saturday night. About miracles and healing and my small part in those things. And about my understanding of eternity, and more importantly, eternal families.
I put my pager on the nightstand. My white coat lay crumpled next to the bed with my stethoscope inside.
Then I laid my head on my pillow, and I waited.
Sleep never came, but peace finally did.
Archives: Love is a Beautiful Thing
May 2nd Year:
I walked into a patient room last week and was immediately grateful that I've learned how to conceal shock or surprise as a part of my profession. My patient was in a wheelchair but had no arms or legs. None. She was in her thirties, plain faced and blonde. She looked tired--sick. Three black straps across her torso held her into her chair. I'm not sure I'd ever seen someone with that exact disability and it affected me. "Can you imagine's" filled my head.
She was suffering from bronchitis and after I'd examined her we discussed treatment options. A handsome young man, probably also in his thirties, accompanied her. I had assumed that he was a friend or an aide or what not. She said, "I really want to get better soon. We're getting married in two weeks." She blushed and he smiled.
Some surprised delight must have been evident on my face as I enthusiastically responded, "Congratulations! That's wonderful."
I couldn't stop thinking about it all day. And it made me so happy.
-------------------------------------------------------------------------------------
I had to call a male patient the other day and let him know that his tests had come up positive for chlamydia. As you probably know, this is a sexually transmitted infection, and really can't be caught in other ways.
The man was surprised when I told him this. "My wife and I don't have any other partners--there must be another way this can be contracted."
Crickets.
Can he put the pieces together? Don't make me be the one to say, "Maybe you should double check with your partner on that."
He had recently traveled abroad and so he asked, "Could it be caught in a public bath?"
I repeated the question aloud, while my co-resident, was working nearby. I happened to glance at her face and she smirked, having realized what we were talking about. Seeing her face nearly made me lose it. I've never come so close to laughing at such a terribly inappropriate time. I didn't. Again, the poker face is a hot commodity in medicine.
It can be hard to deliver news to patients--for many reasons--but especially when you're giving out a bitter pill.
I walked into a patient room last week and was immediately grateful that I've learned how to conceal shock or surprise as a part of my profession. My patient was in a wheelchair but had no arms or legs. None. She was in her thirties, plain faced and blonde. She looked tired--sick. Three black straps across her torso held her into her chair. I'm not sure I'd ever seen someone with that exact disability and it affected me. "Can you imagine's" filled my head.
She was suffering from bronchitis and after I'd examined her we discussed treatment options. A handsome young man, probably also in his thirties, accompanied her. I had assumed that he was a friend or an aide or what not. She said, "I really want to get better soon. We're getting married in two weeks." She blushed and he smiled.
Some surprised delight must have been evident on my face as I enthusiastically responded, "Congratulations! That's wonderful."
I couldn't stop thinking about it all day. And it made me so happy.
-------------------------------------------------------------------------------------
I had to call a male patient the other day and let him know that his tests had come up positive for chlamydia. As you probably know, this is a sexually transmitted infection, and really can't be caught in other ways.
The man was surprised when I told him this. "My wife and I don't have any other partners--there must be another way this can be contracted."
Crickets.
Can he put the pieces together? Don't make me be the one to say, "Maybe you should double check with your partner on that."
He had recently traveled abroad and so he asked, "Could it be caught in a public bath?"
I repeated the question aloud, while my co-resident, was working nearby. I happened to glance at her face and she smirked, having realized what we were talking about. Seeing her face nearly made me lose it. I've never come so close to laughing at such a terribly inappropriate time. I didn't. Again, the poker face is a hot commodity in medicine.
It can be hard to deliver news to patients--for many reasons--but especially when you're giving out a bitter pill.
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