Father's Day 2013

I'm usually not so openly emotional. But it's been a rough week, alcohol and chocolate aren't enough, and I need to release some emotions.

This is for all those who are without their dad today. Whether it is because of distance or disagreement, divorce or death, he is not with you for a reason, and I get it.

This is my first father's day without my Dad. It hasn't been an easy day and it's only lunchtime... Ok, let's be honest, it's been a shitty day and a shitty week. I have a sneaky suspicion next week won't be great either. 

I miss him. I really do. He isn't there anymore. And I took it for granted when he was. Even when I knew we didn't have him for much longer, I still took each day for granted. I didn't call as much as I should have. I didn't ask for the answers to all the questions tumbling around in my brain, even though he always knew the answer to everything. I didn't say "I love you" enough.

This isn't survivor's guilt or some other form of that. It is grief. It is knowing that even though I'm doing exactly what you always knew I would be best at, it breaks my heart that you don't get to see me do it.

This isn't a sympathy ploy either. I have been so blessed by my dad and by the other father figures in my life. If you ask me, I have had more than my fair share of amazing father figures. And they have all been wonderful! From the dad's of friends who always watched out for me and loved me as a daughter, the church leaders who were spiritual fathers, to the Coffee Guys who have been outstanding substitutes. My cup overflows with fatherly love and support. 

Nonetheless, today is a bittersweet day.

I think about Father's Days of the future and helping the father of my future children to celebrate but all the while knowing my kids will never know you. And you were so great with kids. Your whole being lit up when they were around. And I wish my kids would have been able to meet you.

So friends, as you celebrate this day with your dad, take time to remember those of us who are without our dads today and may be hurting a little more than usual. Remember how precious this time with your dad is, and don't take for granted these special moments. Life is fleeting.

Also, remember to honor the people who are stand-in dads: the step-dads, single moms, grandfathers, and all around good people who step up to the plate when a father figure is needed. They are stronger than any of us know. Being a dad is so much more than donating half of the DNA.

A New Day Dawns

The sky is always darkest before the dawn

When a "code blue" is called in the hospital it means that a patient is not breathing and that every doctor and nurse goes running to help that patient. As a newly minted doctor, when our second code blue was called last night I knew I was not going to be very helpful. But as I observed my colleagues attempt to save the patient's life, my focus and heart were drawn to the distraught parents weeping in the corner of the room.

I maneuvered toward them as best I could in the crowded room. They clung to each other as they wept over their child. I put my arms around the mother to help her stand strong for her child. I explained as best I could every detail to the father as the team struggled to save his baby. And I mustered all my strength to keep from weeping with them. For though I can't fathom the pain of losing a child, I too am losing a family member to cancer.

My father was diagnosed with hepatocellular carcinoma last January. We have known for a while this was a possibility, but the news still stung. I won't lie, it took me 6 months of therapy to fully grasp all my emotions. And lately, as his prognosis has gotten shorter and his options fewer and his quality of life poorer, I find that I am distancing myself from the situation.

When I was home for Thanksgiving, my dad had a really bad day, which included some incontinence. Without thinking, I put him in the shower and began to clean. I didn't realize I had completely gone into "work-mode" and shut off all emotional ties. How terrible! It wasn't until later that I realized what I had done and how cold that must have seemed to him.

My dad was admitted to the hospital again yesterday for critical blood counts. And as I stood next to that family I wondered who would be standing next to my family when we were in the same situation, something not too far down the road. And then I thought about the families who lost loved ones in Newtown, CT, last week. Who was there with them? Who was with each life before it was taken too early?

I left the hospital with a heavy heart and I am writing this with a heavier one. Though I am on my way to see my family, I know this could be the last time I see my dad alive or as well as he is. And I remind myself we do not know the hour or the day, we can only enjoy the now.

I want to leave you with that. Enjoy the now. Don't waste it. Don't spend it fighting. Don't part without I love you's. Embrace it! Live in it! Be it!

Enjoy the now.

Tears

A friend from high school went into labor on Saturday. After 40 weeks of growing a baby and 23 tough hours of labor, she delivered a baby boy who's heart stopped beating just minutes after delivery. The doctors were not able to revive him.

My heart broke when I heard the news last night. Though she and her husband live far away from me, I had been attentively following the progress of her pregnancy through the wonders of the internet.

How do you express the grief and devastation you feel for someone when you're so far away?

I struggled in sending her a message to convey my condolences, because, how do you tell someone whom you rarely talk to that you grieve for them? That you would wish away their pain? That though you yourself have never felt such a grievous loss, you are crying for them?

I don't know how to talk to her about it and I probably won't because by the time I might see her, it will be months from now. And then how would I bring it up?

As I think about this tragedy, I contemplate my future in medicine. I know that someday, one day, not too far in the future, I will be the doctor giving the news of a loved one's death. I don't think I will ever be able to do so without crying.

Last month, I stood by as my attending physician broke the news to family after family. Working in an ICU, this is an incredibly common occurance. I teared up each time.

It will be worse in Pediatrics. Far worse. And when I think of it, I dread having children of my own, to spare myself the potential heartache. Because no matter what stage you lose a child in, you have lost a child and a parent should never have to bury their child.

But we can't think like this. If we thought this way with everything, would we ever truly live?

We have to take those chances in life in order to experience life.

We have to push past the doubts that plague every decision and live. We have to live.

Oh Whitney...

I'm watching the Grammy's, solely because I don't have to work until noon tomorrow and I need to take my mind off some other things.

I was enjoying some cheese-less pizza with some wonderful friends last night when one of them broke the news that according to Twitter, Whitney Houston had died.

My first response was, "Is this like that Jon Bon Jovi thing? Because I'm not ok with Twitter if they're going to do that again. Bon Jovi me once, shame on you. Bon Jovi me twice, shame on me!"

Nope. It was quickly confirmed by CNN.

I'll admit, my second response was extremely judgmental, something I will blame on growing up in a small town that I successfully escaped from and have 'earned' the right to be judgmental. "Damn that cocaine! It takes all the good ones! And crack is whack!"

I immediately slapped my hand over my mouth! Wow. Utterly disrespectful, no matter how true it might be.

I have been reflecting on her passing most of last night and throughout today while reading Facebook comments, ice skating (which might be the reason I nearly fell more than once), and even during church. We had a special service annointing the sick today and Father Todd remarked on our cultural response to illness and death. He urged us to remember that in all the blessings we receive, life is the most valuable of these and we should respect it and live it to the fullest each day. He also reminded us that death is a part of life and that it should not be neglected nor shunned; it must be respected as much as life itself.

I cannot really put into words how I feel about Whitney's passing. I, along with so many girls/women who lived through the 90's, recorded her version of "I Will Always Love You" onto a tape cassette and sang to it over and over again. And this is coming from a Dolly Parton fan! In a world of questionably famous people, she was a true talent! And her light burned out too quickly.

I've read a lot of commentaries about her death today, most of which were very negative, but my favorite comes from Bill Flanagan on "Sunday Morning". The link is here, but the best quote is as follows:

"Whitney Houston was a public figure her whole adult life. She battled her demons in the public eye. Today, everyone will praise her. Tonight at the Grammys, she will be paid tribute. In the next few days she will be eulogized. That's as it should be, she deserves it.

But wouldn't it be great if all of us could then leave it at that? Let's ignore the gossip press and scandal media that will try to exploit her memory now that she can't defend herself. Whitney Houston touched millions of us, but she does not belong to us. She was someone's daughter. She was someone's mother. Her memory, like her love, belongs to them. The rest of us will always have her music. When the eulogies have ended, let's let Whitney Houston rest in peace."

She was amazing and will never be forgotten and sang one of the most memorable Super Bowl National Anthems. May you find the peace you so desperately sought.

What would you do?

Dr. Jacob Kevorkian died this week. In case you don't know who he is (where have you been living??? under a rock???) Wikipedia does a decent job of summarizing his life and his work here. Or you could read this book:

He actually died in a hospital not far from where I live. I had no idea he was from Michigan. He was born in Pontiac, Michigan, about an hour north of me. He practiced medicine here (as a pathologist, not a general practitioner), did his research in transplants and transfusions here, and advocated much of his end of life beliefs in Michigan.

Whether or not you agree with his politics and convictions, you have to admit the guy had moxy and brought serious attention to a very valid issue in medicine today.

Now, be forewarned, this is not a commentary on my opinions about physician-assisted suicide. So please don't try to glean my thoughts on the matter from what I write here. If you want to know, please ask me directly, don't assume.

This is, however, a thought process on end of life issues that I am currently going through.

I am going to be a doctor one day, it is coming faster than even I realize, and the final days of a patient's life is something I need to know how to handle.

I admit, I have not been in the room during a "final code" on a patient, I haven't had to tell a patient's family that the patient died, nor have I had to look a patient and their family in the eye and tell them this is the end. I dread those moments with all my heart. I have no desire to be the one who has to drop that bomb and explain why what we did/are doing is not enough. It breaks my heart to even think about it. However, it is part of what I am choosing to do with my life and I pray for all the grace and peace in the world when those moments come.

But what breaks my heart even more, is seeing patients in the hospital connected to every machine possible to keep each organ functioning as close to normal as they can. I have seen this all too often.... How can that be considered good quality of life? Yes, it is life, but how would you feel being strapped to a bed surrounded by beeping, clanging, whooshing, clanking machines 24 hours a day, unable to move, not able to relieve yourself, at least not of your own will?

In the hospital, we have meetings for the students, residents, and physicians that are to specifically address Morbidity and Mortality. Notice they are not solely for "mortality", they consider "morbidity" too--that is the state or quality of life. Unfortunately, it is often we find that mortality is the common outcome of a hospital stay. But I wonder, of those patients that we keep alive with their colostomy bags, g-tubes, ventilators, and IV medications, fluids, food, how many are truly happy to be living that way? Yes, life is what we all want, but do we always inform our patients of what "choosing life" will actually mean for them in the long run? And what of their families? Are we even considering what we put their families through, especially now with insurance companies breathing down everyone's neck?

How many physicians take the time to sit down with each and every patient who is broaching a morbidity and mortality issue to discuss the possible outcomes and what they choose for their long term care? Sadly, I think it is very few. I have yet to see any physician do this.

Keith Olbermann has been very vocal about his thoughts on these issues. There was a great interview with him today on NPR regarding his outspokenness on this issue, specifically regarding the death of his father last year. I was really impacted by this today. He and his father had an extended period of time to discuss their choices for the end of his life. They were very fortunate in this, though they had recently dealt with the hospitalization and death of his mother so they were somewhat prepared for what might incur.

As I don't have any patients yet, I haven't spoken with any regarding this yet. I was afforded the chance to talk with my own family about it, very recently. In September, my dad was hospitalized for a number of days and my mom and I had some good discussions regarding his care and what she thought he would want. We were very fortunate that he came out alright with only a few life-long complications resulting. And then, a couple months later, my aunt was hospitalized and my dad, being the eldest and closest to her, had to make some tough decisions. He and I were able to have some very serious and poignant discussions about what was the right thing to do in these circumstances and what he thought would be best for his own long-term care.

For all those health professionals out there reading this, please consider having these discussions with your patients. Even if they're 85 and in great health, they are more likely than a 16 year old boy to get into a serious car accident, and then what do you do?

And for everyone else, I encourage you to bring up these conversations with your loved ones. It is unfortunate when we have to spend hundreds of thousands of dollars to keep trying to save someone who wouldn't have wanted the care anyway, but no one was there to tell us that.

Again, this is not meant to be a diatribe about end of life issues, but rather a discussion. I hope it brings thoughts and discussions to all who read it.

*Note: I am writing this and listening to Rosie Thomas. Her music inspires deep thoughts in me and I would recommend her for any thought provoking situation or rainy day or long walk.