Cancer at Christmas

The hospital slowly empties as the holidays near as people try their hardest to get home in time for Christmas and postpone treatments and surgeries for after the new year.  I am currently on a rotation with a fair number of patients that have cancer, many of them with a new diagnosis and pretty advanced disease.  I have been on oncology services before and treated patients with cancer, however cancer at Christmas is different.

Today, I just sent a patient home with very advanced pancreatic cancer.  His wife took me aside before they left and thanked me for everything and said she wanted to make sure everything was in order for him to make it through the holidays without needing to come back into the hospital before beginning yet another round of draining chemo.  His entire family was coming in for the holidays.  They had plans for big dinners and lots of celebration.  Everyone was waiting at home for them to return.   They all knew what none of them could say... this may be his last Christmas.

What an awesome weight his wife must carry as she supports her husband and organizes his care with always the hint of a tear in her eye.  What must it feel like to enter the holidays knowing it could be your last.  To hug your children and know you will miss what remains of their life... the grandchildren you may never meet, the guilt of knowing you won't be there for them when they need you.  As I said good bye today I prayed for him.  I prayed for his wife, I prayed for all my patients facing what may be their last time of celebration, their last major memory of the most important people in their lives.

Its been awhile...

So, I haven't written in a while, I have a few half done posts - one about my best call night ever where I was on call with 3 other women, another was a reflection of my last rotation where I operated and got to see what its like to actually be a surgeon, and another on my irrational fear of movie theaters (a side effect of trauma call) - however, I just haven't been able to write them.  It has nothing to do with time constraints.  My time is no different now than before, for a while it was even better.  I just lost the energy.  Maybe this year just isn't new anymore.  I don't know why I can't write anymore, so I'm writing this post about not writing in hopes of getting myself back in the habit.  That's all for now.

me

Inevitable, Part II

Two days later and my neck and shoulders are still cramping from the chest compressions. Two days later and I keep seeing blank eyes staring at me. Two days later and the answers still aren't clear. I spoke to this patient hours before she died, she smiled. Thats the face I see during daytime flashbacks, but in my dreams all I see is the blank stare of her eyes during the code. Two days later and I still don't feel anything.

Its a common question to physicians, "How do you deal with death, do you desensitize yourself to it?" I never understood how that could be possible, but two days after giving violent chest compressions, two days after someone told me "good job" despite the fact that the patient died, I still feel nothing. But the thing that gets lost in the idea of desensitized doctors is that feeling nothing is not feeling normal.

My mind, my body, my spirit seems out of sorts, but I don't know what to do about it. I have no tears, no words, there is nothing but the mountain of work before me.

Writing myself happy

Ok, so I'm descending deeper and deeper into a hole of misery and I'm officially declaring it done.  For the last few days I've found the misery to be more comfortable to any attempt at positivity, but enough already.  I keep focusing on everything that is horrible and letting the great stuff that happens just slide by.  I get so sad about not having time to spend with my husband that I'm polluting the little time we get. We both are, we're both so tired and overworked that we're shortchanging ourselves.   I'm writing it out, writing it over.  I embrace the parts of surgery that I love, I embrace happiness.  I embrace trusting myself and will hold to the belief that despite the negative and weak people in my work life, my hard work will ultimately speak for itself.  I am happy to go to work tomorrow.  I will learn.  I will have new experiences.  I will take steps towards becoming the surgeon I am meant to be.

A rant...

Its 10:00pm on Sunday and I refuse to go to sleep, refuse to allow more life to be taken away to the madness.  I have to be in around 4:30 or so tomorrow.  This week is going to be a rough one.  I'll have 3 long days this week and Saturday call so its pretty much bound to be a 100+ hour week.  I feel inept, I can't do this stuff fast enough, I don't know what to do with these people whose blood pressures won't go down.  I am sick of seeing people without legs.  People keep dying.  People who walk in the hospital looking normal but have a ticking time bomb in their belly.  Lately it seems instead of giving them a chance, we're just hastening their deaths.  I think I'd much rather die suddenly in my house after feeling fine, then die after a week on maximum support with organs and limbs successively being removed until by body gives up.  

I went to church today.  I needed it.  Needed it to make it through what will be a trying and very long week.  I needed a new way to look at all this.  I left church able to see a goal worth working towards, and for now all I have to do it get through this week.  I left knowing that when the time comes I will be able to draw some extra strength from somewhere.  I left feeling like I'm not going into this week all alone.

I still refuse to go to sleep.  I claim this time for me.

Hiatus...

I am on vascular, many of you will know what that means, I barely have the time or energy to breath, so I will likely postpone further posting until its done!

The funnest video game ever!

As some of you may know, my operating experience has hit some recent highs.  Last week I did a right colon as first assist (I could barely breath the whole time from both excitement and total nervousness) and it was one of the most amazing things I've ever done in my life!!  However, despite my constant excitement over my increasing operating responsibilities I still felt a dread for laparoscopic surgery.  My biggest worry in becoming a surgeon was that I would hate laparoscopic surgery and be unemployed since everything is heading in that direction.  As a medical student "driving the camera" is by far the most painful job ever, the camera is never right, its dark, you're standing in some weird contorted position, and if someone is struggling it just gets long and tortuous.  Well this week I had my first try at flexing my laparoscopic muscle and . . . its freakin' awesome!

Just to ease any concern, my laparoscopic debut was not in a patient.  Allowing me to blindly stick hot sharp stuff through some holes in someones belly at this stage would be a bit premature.  However, in a very real appearing setting, I got to do a laparoscopic splenectomy and it was like playing the funnest video game ever!  There is so much strategy involved at every stage, from placing the ports to instrument choice, where to go first. It takes lots of visualization and planning.  I LOVE IT, LOVE IT, LOVE IT.  Now I can feel much better about all the hours I've spent in the past procrastinating on my playstation!

Peanut Butter and Graham Crackers!

Those who live in the hospital know that the staple of the resident diet is peanut butter and graham crackers.  The best breakfast, lunch and dinner you can find in the pantries of every hospital floor.  Why is it that every hospital is stocked with peanut butter and graham crackers!

Now, for the moments where thirst is the predominate need, there is a wonderful selection of beverages, boxed juices chock full of high fructose corn syrup and terrible diet caffeine free 1.5 ounce sodas.  Only the best!

The funniest moment of the week came when one of my co-interns about to get started on the mountain of post rounding orders and discharges took request before going on his pantry run, and we turned our hospital bound Saturday morning into a fancy brunch as we put in our orders for beverages to have with our peanut butter and graham crackers!

Cruising Altitude

I've always liked to write in my journal at cruising altitude, especially if I'm traveling alone. Its the point at which half the plane is asleep, the beverages and snacks have been passed out and all you can see out of the window is a sea of clouds. It has always seemed to me like the perfect time to stop and reflect. So last week, after flying out to go and procure an organ for a tranplant, I reflected at cruising altitude on the way home.

I am thrilled to be on my way to becoming a surgeon. I have loved the operating room since my first visit. A a student I looked on often standing on my tip toes just to get a glimpse, just hoping that maybe I'd get to touch something, or clip some suture string. Every action, no matter how small was a little gift. And now I'm finally not a student and flying out to do my first big case and I'm sort of emotionless. When I make it to the operating room, the joy of being able to touch something is overtaken by the constant state of nervous anxiety, so strong at first I almost want the operation to just be over. Every cut, every tie, every move with the bovie is made by me. I will my normally steady hands to be still. I mentally try and lower by heart rate and stay calm and be accurate and be good, and at the end, I feel almost as though I'd done nothing. Its amazing that one small insignificant tasks as a student can feel huge, such an honor, such a step forward. However, as an intern, each step is carefully shown to me, each move dictated.  The focus is no longer on the chance to do a tasks, but instead a constant attempt to perform actions correctly, it feels so different than I would have expected. As a student I would have given anything to be the intern actually doing all of the steps, it looked so amazing. Now, I realize that the goal always lies one step ahead. It truly is the attending surgeon leading the operation who actually does the operation, I'm just carrying out each request.

Inevitable

As a doctor it is inevitable that I will face death, as a new doctor I have not dealt with that inevitablity until now. This week had been a good week for me, I rode on a private jet for a transplant case, I got into the operating room FOUR times and have actually been able to do things, my hours were manageable, overall it was a good week. I imagined that this post would be about one of those big things until I arrived to work on Friday and my patient was dying. Out of respect for him I will write very little about what actually happened or the details of his death, but instead about what I feel as a result.

Choosing death
The stories are countess. A person tells family that he has had enough, says goodbye...just changes, and shortly thereafter he dies. Amazing our own internal power to sustain life - just highlighting that doctors and medicine will always be limited by the human spirit. My patient did the same thing, although I realized it only in retrospect. On Thursday, I only wanted to encourage him more and planned to do the same thing on Friday. I didn't realize then that it was out of our hands. After weeks of losing control to disease, this was his last statement of independence.

Two sides
I chose surgery because of the ability of a surgeon to immediately affect the process of disease. Cancers removed can yield instant cure. Today I realize that there are two sides to that argument.  What surgeons do is step into the natural process of disease and change its course. The hope is always that the disruption of nature prolongs life, but nothing is without consequence.  The results of surgery can also hasten death.  No statistic regarding human life is 100% good, and 0% bad.  Some will not be saved.

Life leaves
There is a point at which life leaves the body.  As I said goodbye on my way out on Friday I realized that the man I had taken care of for a month was gone.  As I left and held his hand telling him I'd see him on Sunday, I knew in my heart that time would likely never come to pass.  I prayed a prayer without words or request.

Grace
My patient made it through the first day with maximal support, he died when I was away from the hospital.  I originally though I'd want to rush back to say goodbye, to be there.  But, when it actually happened, I was standing in my beautiful sunny kitchen, and I wept alone, with the comfort of quiet.  It was grace that ended his suffering and gave him peace.  It was grace that allowed me to have this moment in the stillness of my own space to grieve for my patient, and his wife and his children and his sisters and brothers and his family and friends and the space he will leave behind.

Selah

But what about life?

Three weeks in and I'm essentially exhausted all the time. My body is in constant sore pain. My last call kept me up all night during which time I had the pleasure of irrigating a rectum, disimpacting another rectum and dressing an anal wound. I left post call right around noon and my husband picked me up. After a quick lunch I was home and sleep on the floor. For some reason I just couldn't get in the bed in the middle of the day. My husband had told me earlier in the week about a work barbecue he was invited to. I had planned to try and go since I was going to be post call and therefore assured to be able to get there in time. I try to attend as much of his stuff as I can because I know there will be lots of stuff I will miss. However as soon as I got home I knew it was going to be tough to wake myself up and make myself decent enough to attend one of his work functions so I told him he may have to just go to this one alone.

By 4 o'clock I was sick of the floor, I woke up briefly to transfer myself to the bed and immediately passed out again. A bit later I groggily opened my eyes and saw my husband kneeling over the end of the bed typing away intently on his laptop. "Hey" I said. "Hey back" he smiled, then I asked when he was heading out to the barbecue, I though maybe I might have time to shower and go with him, but as I asked I looked at the clock. It was 7:30 already and the barbecue started at 6:00. He hadn't gone, but instead had kept vigil at the foot of our bed, "I missed you, this way I knew I'd at least get to see you." I instantly felt like crap, my husband had talked about this barbecue all week, excited that I'd actually be able to come with him since I would be post call. I felt awful that I'm gone so much that kneeling in front of me while I slept was the only way to spend time with me. I wondered if this all was really going to be worth it.

We regrouped, went grocery shopping together and he decided to cook dinner for us! In the middle of food prep, my husband turns around and tells me not to worry about missing the barbecue and said he'd have a light day tomorrow, maybe he'd take off early or call in and we'd do something fun together. "But I have to work," I told him. He was thinking I'd be post call the next day, when I explained that today (the day I slept through) was actually my post call he shouted in exasperation that I work all the time! I miss my husband. I hate that he misses me because I'm not there. Earlier this week he compared our life to dating, where you see each other a few times a week and have fun dates and do special things. And it is true that our time together is very special when we have it, and we always try to make the most of it. But, do I really want to date my husband for 5 years. What will I lose in the process...

The operating room...

I finally had my first case. The highly anticipated first case as a doctor, as a surgeon! And it was shockingly anticlimatic. By the end of the day it was really just a blip in a day of all the regular grind of answering pages, putting in orders, checking labs and vitals, same day to day. But at the same time something feels a little different, like there's a little bit of surgeon swagger in my walk. I must say though that I thought it would feel different. Maybe I have to slow down first before I realize how I actually feel.

Pee ... and poop

My life revolves around pee and poop. Poop by day, pee by night. Each morning I see all of my patients and my major objective, find out if they pooed, or at least farted (excuse me, I mean if they had flatus). If they pass the fart or poo test, they get more food and get closer to going home, hooray!

Now, add diarrhea into the mix and I become a poop consultant. What color, how runny, how solid, how smelley? Oh how fun to talk about poo. Meanwhile, I already rarely get to eat for running around and now I can't eat because I keep thinking about poo. Ughh.

At night, being on call is all about pee. At least one or two people who just got out of surgery is not peeing. Especially older patients. So my mission as intern of the evening is MAKE THEM PEE! Little bolus, big bolus, touch of lasix, wait, more fluid, wait, wait...now PEE! Yellow pee, dark pee, bloody pee, cloudy pee, I am the queen of pee.

Another week survived, only 257 to go. Yesterday I had my first day off! Unfortunately, I can't stop thinking a little about whats going on at the hospital. Looks like I'm hooked.

better...

As promised, my report of week two will be better. Victory #1 - I don't want to cry everyday! Victory #2 - EYE CONTACT, yeah!

Now don't be fooled, this week was quite the emotional rollercoaster, but its 3pm after my post-call nap and I don't feel awful and I think thats pretty good. So here are the up and downs:

Down: Monday morning I got hit with the news that just as I started to feel a little comfortable with my job description, due to shifting in the class above me, I would now have twice the work and twice the call! I was speechless!! A response that was met with a reply that I should just learn to deal with it.

Up: Twice the work turned out to be heavily shared and twice the call really turned out to be procurement call every other day. So, although its a pain to not be able to drink, EVER, if I get called its for the coolest surgery of all! Also, getting in the OR on a case like that as an intern is a pretty sweet deal. Once I realized the upside (with the help of my hubby), I actually got pretty excited and more into my rotation. Also, voicing my excitement to upper levels seemed to earn me some cool points!

Down: I was minus one husband for a lot of this week while he was traveling...lonely.

Up: My interns come through like family every time. I have an intern with me on my team now and its nice to have someone to talk to and get work done with. Also, I had a few post work "please make me happy" hours with other interns which just makes this all more doable.

Down: It sucks when kids don't get the transplant. Especially after they spent the last 4 hours jumping on the bed with excitement, just sucks. Transplant is weird that way, happiness for one is always sadness for someone else.

Up: Randomly, and I mean randomly in the middle of attending rounds, the attending who yelled at me last week apologized! Pretty cool... and it turns out he's a pretty good teacher!

Down: I have not had a day off yet, 14 days and counting...

Up: I have survived two more nights on call and I'm starting to feel like the doctor. I'm not as terrified all the time. I know how to do a few things independently and who to call for help. I can actually think through problems and usually come up with a pretty good plan on how to address them. Also, I realized that I'm far from alone in the hospital when I'm on call, I just didn't know where to find my help before.

So I can conclude that as week two ends, I feel a little more at home. I feel a little less crazed, I feel better...

Back to the South...

I just finished week one. I just finished. I was at the hospital every day. I always heard that you sustain yourself the first few months of intern year with the excitement of being a doctor. My excitement wore off when I woke up at 3:00 am on day 2. . . not very encouraging.

I left a nice, well paying job to join this wonderful profession. I am not a kid anymore. I also left NY and headed back to the red states for residency . . . what was I thinking!

Ok, so being an intern, I have minimal energy right now. Even for blogging, so I'll keep it short and give you some highlights from the week...

• I got yelled at my first night on call - total shift lasted 32 hours with not a second of rest
• Its a lonely life, I spend the majority of my time in the hospital with people I don't know who don't know me.
• I want to cry at least once a day
• One of my attendings doesn't make eye contact with me, he just completely and utterly ignores my presence, even when I'm talking he looks at the other resident (did I mention I'm a black female at a Southern hospital, hmmm...)
• I completely LOVE my co-interns!
• The OR is still awesome, I only made it in for about 30 minutes, but it totally restored my faith.

Ok, so thats it for week one. I'm hoping for a more positive week two and I love my husband, he's awesome.