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.

Why am I doing this again?

There are some days, many days where I question what I'm doing with my life.

When you're the "smart one", the one who doesn't have to study, the one who is always told "you should be a doctor", it seems as though your life is all laid out for you. And it was. Well sort of.


Then the doubts begin. You fail a test. You fail another test. You learn what rejection feels like. You realize how much you do not succeed in your endeavors. You hurt others around you because you keep trying harder and harder to succeed and neglect relationships. 


Work begins and never ends. Ever. All you do is work. And work. And keep working. And people keep asking things from you. Stupid things. And they ask idiotic questions. I mean, really really dumb things... like "How do I not get constipated?" and "How could I be pregnant?" and "Why aren't you giving me more Lortab?"


But then, then something happens to make it all worthwhile. Something that renews your faith in humanity and in your own self.


I was in the ED and picked up a patient with a "foot wound". It had been a long day already and I had a sinking feeling that this would be just another uncontrolled-diabetic-overweight-pain-pill-seeking-angry-patient. The patient was none of those things. And the wound on the foot was not trivial. The patient had seen several doctors in the previous week. As we discussed health history and the history of this foot wound, I began my physical examination. 


I am consistently made fun of in the ED because I do a full exam on all my patients. I keep telling myself that it's good for my education and I'm making myself a better doctor, but I really want to not do it all the same. 


Nonetheless, I did my full exam. When I touched the patient's leg....it felt like a piece of fragile bubble wrap. I immediately called surgery.


I got lucky. And, I guess, so did the patient. I could have just ignored the complaint or skimped on my examination. But I didn't. And my patient lived. 


So, to answer my question: I do it to save lives; for moments when my patient grabs my hand, looks me in the eye, and says, "Thank you. Thank you for helping me"; for the realization that I'm doing what I'm supposed to do. 

I apologize for the "woe-is-me" nature of this post. But I have a feeling I'm going to need this reminder in the future. Probably more than once.

Graduation

It's official: I'm a doctor!

Holy crap. I just read what I just wrote.... I'm not ready for this! School!! TAKE ME BACK! Don't let me go yet! I need more time! I'm not done learning yet!!! PLEASE!!!!!!!!

Sorry about that. Minor outburst of insecurity. Pay no attention to the apprehensive 5 year old running things behind the curtain, she has no idea what she's talking about. I'm back, full of confidence! At least I think I am...

Moving on....

I don't know how to put words to graduation week. It doesn't help that I was fortunate enough to go to 2 beautiful weddings for 4 wonderful friends before and after graduation. I was gone from home for 3 weeks....

That said, I'm just going to post some of my favorite pics. I'll put captions so they make some sense. 

the siblings, and our adopted sibling Olga (Olivia) at the first wedding in Hawaii

me and the lil bro on scooters after the first wedding

me getting DANCE BOMBED by the bride and groom at the second wedding (I was oblivious)

2 of my favs! John Thurman & Todd Brubaker

We take those Tough Mudder headbands EVERYWHERE!!!

burning that DAMN short white coat! Sayonara bacteria! 

me getting hooded (you get a hood when you do a post graduate degree) by one of my fav professors

with the lil bro and lil sis post graduation

with the big bro and his wife and 2 daughters

with my 2 aunts (2 of my dad's sisters)

with my med school brother! <3 you Toddington! 

SOCIETY 7!!! Best group a girl could ask for!

Proud papa!

me and the mama with our coffees! Seattle girls to the core! (and you can see my dress in this pic)

 It was a whirlwind week and I am SOOOOOOO blessed with all the support from friends and family the last 4+ years! Much love to you all!

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.

Scrubs didn't teach me this stuff

After a long 4 weeks in the Emergency Room, I won't lie, I learned a lot!

I will be listing a few of the hi-lights of my mandatory time in the following bullet points. If you have no desire to understand more about the inner workings of a South Detroit ER or you find my medical school ramblings tiring, tune in later this week when I shall be discussing something much more stimulating such as Dunny's or stories from Impromptu Roommate Date Night.

To those of you still in attendance, beware, the following tidbits of information might make you not want to attend your local ER. Either that or you'll be sure to charge your smart phone to take videos the next time you come to visit....

• Name Game.

There will always be someone in the ER with an odd name. Without fail, someone comes in with some bass-ackwards way of pronouncing a simple name, or their parents just strung a bunch of random vowels and consonants together. It. Is. Ridiculous! And entertaining to see who can figure out how to pronounce it first.

• Style
  
  
  
  People dress up to come into the ER like they dress up to go to Walmart. If you've never been to an ER to see some of this eye-catching style, just pop on over to People of Walmart.

You get the idea now?

• Children

There is always a parent who, regardless of age or race or economic status or number of children, will bring their child into the ER at some God-awful time.... And more often than not, they have no good reason to be in the ER. None whatsoever.

• 9-1-1
  Approximately 1/2 of all 9-1-1 calls are for things that EMS is not needed. As in, the callers should have called their Family Doctor, not 9-1-1.

• Longest. Wait. Ever.

The reason you wait so long in the ER is because you are not the only person in the ER. Either that or you're one of the people who shouldn't be there and we're making you wait because we can't handle the stupidity......

• Favorites

We don't pick favorites. Usually the patient we're spending more time with than you is actually significantly more sick than you are. And by that I mean, they're probably on the actual verge of death rather than you're perceived "I'm dying from this back pain I've had for 6 years"

• Yes, the food sucks.

Trust me, I know. I've eaten it, and worse. But while you're getting 2 hour old chicken with mashed potatoes from a bag and jello-like gravy, I'm chowing down on Graham Crackers. Yep, I get Graham Crackers and ginger ale for my lunch, dinner, and snack during my 10 hour shift. I know, you're jealous...

• Sutures

They're way more scary for the person putting in the stitches than for the person receiving the stitches. And, if you work it just right, you can make that forehead laceration look like a Harry Potter scar, though you might want to check with the patient first.

• Temperature

A fever isn't truly a fever unless you measure over 100.4 degrees Fahrenheit. Nor is it a true body temperature unless it is measured rectally. Yep, thermometer in your butt.

• Glove Up

One should wear gloves at all times in Emergency Room. And you should wear a mask. Even if you're the patient. At all times.

• Drugs

If you're looking to score something, legal and illegal, you are likely to find someone in the ER to give them to you. Although, the doctors are far less accommodating than the patients.

• Nurses

Best. People. Ever.

And they're not afraid to tell the truth to anyone. And I mean anyone!

Ok. I think that's enough for tonight. The ER is a scary place, I don't really recommend it. But ER's are staffed by some really brilliant doctors, and they have more grace than I have ever been able to muster.

Also, show some love to your local emergency personnel, especially those who drive the emergency vehicles with the sirens. If you hear a siren and see flashing lights, just pull over. They need the space to drive and they might be saving a life. Give 'em a brake! (har har)

Sorry I've been so busy....

This is the time of year for us 4th (and FINAL) year medical students that we travel around to different hospitals looking for someone to hire us for residency.

This is a BIG deal! And it is very nerve wracking!

I've been working on my applications (which I actually have finished, I just haven't submitted) for weeks and weeks..... UGH! I'm so tired of talking about myself.

But, back to the traveling.

Last month I got to spend 4 very fun weeks in the tidy city of Tulsa, OK. Now, I'm sure many of you think of this when you hear Oklahoma. I would encourage you to lean a little more toward this or this.

It's such a cool little city and the people are incredibly nice!

But now, I've left. I've moved on to a much bigger city....

Do you know where I am???

Ok, how about in the daylight? Any guesses?

Now, I'm giving you a huge hint. I see this lady (in the red circle) everyday on my way to work!

YEP! NYC baby!!! It's fast! And it's busy! It's also kinda smelly. I thought that might be from the recent hurricane, but I stand corrected, that's just the way it seems to smell all the time.

More on my adventures later. Now I have to run and find patients!

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.