The first official doctor pay-check was deposited into our accounts last week, incredibly anti-climactic, it seemed smaller than I had imagined. Quite funny, they calculate pay assuming you have worked 67.5 hours in two weeks. I kept on staring at the pay slip trying to figure out why it said 67.5 hours. Do normal people actually work that many hours? Isn't that part time work? I work more than that in one week. Oh, I wish I was normal! (Yes, go ahead and laugh). The calculation per hour, something I really shouldn't have done, works out to just under $9/hour. Which I believe is just under minimum wage in BC. Tim Horton's here I come!
Don't get me wrong, I'm not exactly complaining about it, this is a 900% improvement from the $1/hour you get as a final year medical student (minus tuition of course), but I imagined I might actually be able to get out the the red. BC's standards are just too high. Lets review my recent costs:
My rent has doubled.
My car insurance has doubled (screw you ICBC!)
My blueberry addiction is costing me $2.96/day.
My car (which was serviced in June in Alberta) needed an inspection to get registered ($152), the tail light was burnt out ($28), the front brake pads were the wrong size and worn out ($190), the brake wheel cylinders were cracked and leaking ($90), and my brake fluid needed flushed ($10, optional). Total $950.
Sushi obsession ($8/call shift).
My stethoscope was stolen ($238 + tax).
Skinny-little textbook on how to dictate obstetrics and gynecology surgeries ($121).
Fenders for my bike ($15).
Did I mention blueberries ($2.96 daily)?
Okay, this is getting boring, but you get the picture. I'm hemorrhaging money faster than Lenny Kravitz in a guitar shop. I can't believe I spent over $1000 today, just on a car and a book!
So I came up with a plan (of sorts), okay, its not even really a plan, just some random ideas all in succession that will help me get out of debt, brainstorming shall we say.
1) Get my budget-minded sister to assess my finances and make a plan when she comes to visit.
2) Sell my car (its just too pricey), and buy a road bike AND a macro lens for my camera.
3) Cancel #2 since it cancels out the money I would have gained by selling my car.
4) Get a sugar-daddy.
5) Start a drug dealing business with my newly acquired prescription writing skills and easy access to the down town East-side.
Fine, I give up. I'll just keep working, the rest of the world has to do it to survive, why shouldn't I? Ultimately, life's not really about the money, I wouldn't trade the blueberries for cheaper rent anyway.
Tuesday, July 31, 2007
Saturday, July 28, 2007
Thursday, July 26, 2007
I see dead people
Deceased. It just popped up on my patient list next to her name. That was it. Done. Not that we hadn't know this was coming, she was in the ICU and had been deteriorating for weeks but it seemed like an abrupt ending. She had come in off the street, initially admitted for psychosis (i.e. craziness) she had then slowly lost consciousness and developed sepsis. Kidney failure, liver failure, and a mushy brain . . . all just kind of unexplainable. I had seen her several times, they were trying to rule out any gyne causes. Then suddenly 'deceased' on my list. Everything felt numb. I have trouble imagining people dead, since all my memories of people are so alive.
I'm in obstetrics because I don't like sick people and I don't like dead people, its simple. 95% of the time, you get a happy healthy mom, a gurgling happy baby, and a proud as heck dad out of the deal, its all happy clappy. Patients hug you and take pictures of you and buy you cherries and chocolates and cinnamon buns. But today was different, it was just a bit soul destroying. To call it tragic and heart-breaking doesn't even begin to describe it. My day started and ended with the same word.
The woman came is last night, 28 weeks pregnant and with horrible abdominal pain. So much that we couldn't even examine her without giving morphine, screaming out in pain. The first thought was abruption, bleeding in the uterus when the placenta pulls away from the wall. But baby looked fine, all the lab results were normal, just excruciating pain. She had been into the emergency room twice before with similar pain, chalked up to constipation, it resolved, and she went home. We were just talking about her in rounds when I got paged. A distressed emergency doc was on the phone. "She's gone tachy, she looks terrible, and I can't get a fetal heart. I need you here now."
I grabbed a senior resident, realizing immediately this was way out of my league. Within minutes we knew. It was an IUFD. We talk in code. Intra-uterine fetal demise.
She's white as a sheet, snowed on morphine but still in pain, heart rate through the roof. Ultrasound is repeated, its now been done four times. I've seen dozens of scans and there's nothing as bone chilling as seeing the spine and rib cage with no tiny heart moving up and down. The husband stands by the stretcher in the trauma room, squeezing her hand, stroking her hair. Her fingers look so pale they are nearly translucent in his strong brown hands. We walk in and out of the room, hushed tones, "get the attending here stat." It seems sick and twisted that we can't tell the husband until we've dotted all the i's and crossed the t's. "Medico-legally imperative" I'm told. A wave of nausea sweeps over me, I'm disgusted at the system I am so actively a part of. A husband is watching his wife writhe in pain, knowing that something is wrong with his child, asking and asking but we can't officially tell him. Frustration, anger, pain.
Finally they know, her eyes dart around the room, I see terror and confusion in her eyes, it makes no sense. The father, well-built and articulate chokes with emotion. "But it was fine, 8 hours ago the baby was fine. How did this happen? The baby was fine!" Why, why, why? Dozens of questions, anger spilling out at this injustice, this tragedy of horrific proportions. Talking to the emergency physician her eyes well up and she holds her head in her hands. She was on all night, saw the patient when she came in and woke her up this morning to check on her. "Let's play the what-if game, what did I miss?" The answer, for now, is nothing. Because no one can carry that weight on their shoulders without being crushed.
As if the loss of a child is not painful enough, the initial plan was to induce labour. An emotionally laden process.
That didn't happen, mom 'crashed'. She was rushed to the OR for an emergency C-section. Dead baby out. Uterus sewn up. Then all they can see is black small bowel. Five feet of dead gut. That's what caused her pain. General surgery comes in, of course you can't live without a gut, so they sew her up and send her to ICU, intubated, ultimately to die.
Numb. A man has lost a child and then his wife, can life ever go on? She's someone's daughter, someone's sister, someone's best friend and she would have been a mother. He thought she was constipated and now she dead.
I want a debriefing session, to sit with everyone involved and talk of the horror, to reassure each other that we didn't miss anything. I want to process this, to try to understand what just happened. But my pager just keeps on going off.
I'm called to see a distressed woman, emotional and crying after bleeding for weeks after a D&C for a miscarriage. "I just want it to be over, I need closure. This isn't fair, I still feel like I'm pregnant, my breasts are still full, but I keep on passing these clots. When will it be over? Is it blood? Is that a piece of baby coming out? I can't handle this, I need it to be over." Sobbing, nearly hysterical. I listen and listen, and empathize and reassure and book her for the OR for another D&C. I don't even leave the ER before I get grabbed for more consults. A cyst next to someone's urethra (yawn), bleeding that won't stop, pain and pain and pain. Then a woman who blacked out and rolled her car . . . and is 16 weeks pregnant. Scared. A broken arm, a worried husband.
If anyone says that the medical system is uncaring and doesn't feel pain I will dispute it with passion. All day in the emergency department, in the halls, on the maternity ward, nurses, residents, and attendings stopped me to ask if it was really true. If this unbelievable tragedy had really happened right in front of our eyes. It was as if as the first obstetrics resident on the scene I could offer some insight, some reassurance, a person they could identify as a place to share their grief. If I could have stepped out of my own emotions around the issue I probably would have found it fascinating.
I keep going and going, trying to fully engage with each person and their own personal pain but I'm drained. I have nothing more to give. Numb. As I write up the notes I find myself zoning out and starring at the page without focusing. By 4pm I can't stop my hand from shaking as a pick-up the phone to return a page. At that point I realized that I hadn't eaten or had a drink since 5:30 this morning. In fact, I hadn't even peed since then, what am I? Superhuman? At which point I raid the limitless supply of egg-salad sandwiches and potent orange Tang in the ER fridge.
This is the worst job on earth, there's nothing but pain. Why can't I make lattes for a living, where a bad day means that I used 2% instead of soy and the espresso machine is broken?
But at the end of the day, I get to go home. To splurge on creamy Greek yogurt and stacks of local blueberries. I pound out every ounce of anger, sadness, and sheer emotional exhaustion into the pedals of my bike. Disappearing into the thick cool forest of the endowment lands, skidding around corners, speeding down the hill to the ocean and along the coast. I can leave that pain behind and start a new day, but they can't, because ultimately its their pain and not mine. I can only try to share it with them when I'm present in their reality, in some watered-down version. No, I don't really want to make lattes, I want to be present with people in their pain, this is real, this is life.
I'm in obstetrics because I don't like sick people and I don't like dead people, its simple. 95% of the time, you get a happy healthy mom, a gurgling happy baby, and a proud as heck dad out of the deal, its all happy clappy. Patients hug you and take pictures of you and buy you cherries and chocolates and cinnamon buns. But today was different, it was just a bit soul destroying. To call it tragic and heart-breaking doesn't even begin to describe it. My day started and ended with the same word.
The woman came is last night, 28 weeks pregnant and with horrible abdominal pain. So much that we couldn't even examine her without giving morphine, screaming out in pain. The first thought was abruption, bleeding in the uterus when the placenta pulls away from the wall. But baby looked fine, all the lab results were normal, just excruciating pain. She had been into the emergency room twice before with similar pain, chalked up to constipation, it resolved, and she went home. We were just talking about her in rounds when I got paged. A distressed emergency doc was on the phone. "She's gone tachy, she looks terrible, and I can't get a fetal heart. I need you here now."
I grabbed a senior resident, realizing immediately this was way out of my league. Within minutes we knew. It was an IUFD. We talk in code. Intra-uterine fetal demise.
She's white as a sheet, snowed on morphine but still in pain, heart rate through the roof. Ultrasound is repeated, its now been done four times. I've seen dozens of scans and there's nothing as bone chilling as seeing the spine and rib cage with no tiny heart moving up and down. The husband stands by the stretcher in the trauma room, squeezing her hand, stroking her hair. Her fingers look so pale they are nearly translucent in his strong brown hands. We walk in and out of the room, hushed tones, "get the attending here stat." It seems sick and twisted that we can't tell the husband until we've dotted all the i's and crossed the t's. "Medico-legally imperative" I'm told. A wave of nausea sweeps over me, I'm disgusted at the system I am so actively a part of. A husband is watching his wife writhe in pain, knowing that something is wrong with his child, asking and asking but we can't officially tell him. Frustration, anger, pain.
Finally they know, her eyes dart around the room, I see terror and confusion in her eyes, it makes no sense. The father, well-built and articulate chokes with emotion. "But it was fine, 8 hours ago the baby was fine. How did this happen? The baby was fine!" Why, why, why? Dozens of questions, anger spilling out at this injustice, this tragedy of horrific proportions. Talking to the emergency physician her eyes well up and she holds her head in her hands. She was on all night, saw the patient when she came in and woke her up this morning to check on her. "Let's play the what-if game, what did I miss?" The answer, for now, is nothing. Because no one can carry that weight on their shoulders without being crushed.
As if the loss of a child is not painful enough, the initial plan was to induce labour. An emotionally laden process.
That didn't happen, mom 'crashed'. She was rushed to the OR for an emergency C-section. Dead baby out. Uterus sewn up. Then all they can see is black small bowel. Five feet of dead gut. That's what caused her pain. General surgery comes in, of course you can't live without a gut, so they sew her up and send her to ICU, intubated, ultimately to die.
Numb. A man has lost a child and then his wife, can life ever go on? She's someone's daughter, someone's sister, someone's best friend and she would have been a mother. He thought she was constipated and now she dead.
I want a debriefing session, to sit with everyone involved and talk of the horror, to reassure each other that we didn't miss anything. I want to process this, to try to understand what just happened. But my pager just keeps on going off.
I'm called to see a distressed woman, emotional and crying after bleeding for weeks after a D&C for a miscarriage. "I just want it to be over, I need closure. This isn't fair, I still feel like I'm pregnant, my breasts are still full, but I keep on passing these clots. When will it be over? Is it blood? Is that a piece of baby coming out? I can't handle this, I need it to be over." Sobbing, nearly hysterical. I listen and listen, and empathize and reassure and book her for the OR for another D&C. I don't even leave the ER before I get grabbed for more consults. A cyst next to someone's urethra (yawn), bleeding that won't stop, pain and pain and pain. Then a woman who blacked out and rolled her car . . . and is 16 weeks pregnant. Scared. A broken arm, a worried husband.
If anyone says that the medical system is uncaring and doesn't feel pain I will dispute it with passion. All day in the emergency department, in the halls, on the maternity ward, nurses, residents, and attendings stopped me to ask if it was really true. If this unbelievable tragedy had really happened right in front of our eyes. It was as if as the first obstetrics resident on the scene I could offer some insight, some reassurance, a person they could identify as a place to share their grief. If I could have stepped out of my own emotions around the issue I probably would have found it fascinating.
I keep going and going, trying to fully engage with each person and their own personal pain but I'm drained. I have nothing more to give. Numb. As I write up the notes I find myself zoning out and starring at the page without focusing. By 4pm I can't stop my hand from shaking as a pick-up the phone to return a page. At that point I realized that I hadn't eaten or had a drink since 5:30 this morning. In fact, I hadn't even peed since then, what am I? Superhuman? At which point I raid the limitless supply of egg-salad sandwiches and potent orange Tang in the ER fridge.
This is the worst job on earth, there's nothing but pain. Why can't I make lattes for a living, where a bad day means that I used 2% instead of soy and the espresso machine is broken?
But at the end of the day, I get to go home. To splurge on creamy Greek yogurt and stacks of local blueberries. I pound out every ounce of anger, sadness, and sheer emotional exhaustion into the pedals of my bike. Disappearing into the thick cool forest of the endowment lands, skidding around corners, speeding down the hill to the ocean and along the coast. I can leave that pain behind and start a new day, but they can't, because ultimately its their pain and not mine. I can only try to share it with them when I'm present in their reality, in some watered-down version. No, I don't really want to make lattes, I want to be present with people in their pain, this is real, this is life.
Monday, July 23, 2007
Village Idiot
For as long as I can remember, I have made people laugh. And for equally long, I've never known whether people laugh because they think I'm an idiot, or because I've said or done something genuinely funny. Are they laughing at me, or because of me? The conclusion I've come to is probably a bit of both.
Today I was on the gynecology service, it was a bit of a slow day, no one with a raging pelvic infection or a ruptured tubal pregnancy needing rushed to the OR. So I was sitting reading relevant academic literature for part of the day on the labour and delivery floor. The other residents being busy with doctor-type stuff a nurse decided I would do, and asked me what I thought was a pretty funny question, so I responded (I thought) accordingly. She was charting, and couldn't think of how to describe a procedure done on a newborn.
"He has a little skin tag below his left nipple and the pediatrician has tied a suture around it [to make it fall off], what's that called?"
"Oh yeah, the medical term for that is a 'nubin', like a third nipple, just like Chandler had on Friends. The procedure is called 'castration', its the same thing they do on little calves testicles with an elastic band. So you could write 'nubin castration noted' in the chart." I said matter-of-factly.
Pause.
Burst of laughter.
People keep on commenting on how studious I am (funniest joke EVER), the attending staff does some teaching with me and one of the other junior residents, of course I ask scads of questions, because really, why not, when someone's teaching you. Somewhere along the way (and for the life of me I can't remember when), between my joking with nurses and residents, reading about inducing labour and eating cherries one of the patients gave us, the attending obstetrician asks me what program I'm in. When I reply 'OB' she bursts out laughing. Not just a bit of a chuckle, but side-splitting laughter. So much so, I was worried that not only would she fall off her chair and fracture something but that she might lose voluntary control of her bladder. Tears started rolling down her cheeks, her face went red, and she couldn't even talk. The whole nursing station now stops to try and figure out what on earth is happening. I helpfully pipe-up: "I think she's just shocked that I'm such an idiot." To which of course, everyone laughs anew, the attending now gasping for air.
The same feeling came over me when I was determined to learn how to carry water on my head in Tanzania. Everyone gathered around the water tap for entertainment. Its a mixture of profound embarrassment and feeling like you are contributing to community or team dynamics by providing quality entertainment.
So much for being a professional, eloquent doctor. I will probably always be just a bit of a village idiot. Humility 101.
Today I was on the gynecology service, it was a bit of a slow day, no one with a raging pelvic infection or a ruptured tubal pregnancy needing rushed to the OR. So I was sitting reading relevant academic literature for part of the day on the labour and delivery floor. The other residents being busy with doctor-type stuff a nurse decided I would do, and asked me what I thought was a pretty funny question, so I responded (I thought) accordingly. She was charting, and couldn't think of how to describe a procedure done on a newborn.
"He has a little skin tag below his left nipple and the pediatrician has tied a suture around it [to make it fall off], what's that called?"
"Oh yeah, the medical term for that is a 'nubin', like a third nipple, just like Chandler had on Friends. The procedure is called 'castration', its the same thing they do on little calves testicles with an elastic band. So you could write 'nubin castration noted' in the chart." I said matter-of-factly.
Pause.
Burst of laughter.
People keep on commenting on how studious I am (funniest joke EVER), the attending staff does some teaching with me and one of the other junior residents, of course I ask scads of questions, because really, why not, when someone's teaching you. Somewhere along the way (and for the life of me I can't remember when), between my joking with nurses and residents, reading about inducing labour and eating cherries one of the patients gave us, the attending obstetrician asks me what program I'm in. When I reply 'OB' she bursts out laughing. Not just a bit of a chuckle, but side-splitting laughter. So much so, I was worried that not only would she fall off her chair and fracture something but that she might lose voluntary control of her bladder. Tears started rolling down her cheeks, her face went red, and she couldn't even talk. The whole nursing station now stops to try and figure out what on earth is happening. I helpfully pipe-up: "I think she's just shocked that I'm such an idiot." To which of course, everyone laughs anew, the attending now gasping for air.
The same feeling came over me when I was determined to learn how to carry water on my head in Tanzania. Everyone gathered around the water tap for entertainment. Its a mixture of profound embarrassment and feeling like you are contributing to community or team dynamics by providing quality entertainment.
So much for being a professional, eloquent doctor. I will probably always be just a bit of a village idiot. Humility 101.
Thursday, July 19, 2007
Wanted: Fenders and a Brolly
Apparently it rains in Vancouver.
I know, I know, this is not something I hadn't heard before, but now I've actually experienced it. For several weeks now as I drank in the glorious sunny days and beautiful evenings I've thought this 'Vancouver is rainy and gray' stuff was an unsubstantiated, vicious rumour. Turns out its true.
Monday morning dawned gray and soggy. I grabbed my fancy gortex jacket (yes, the one that I could have fed a small village for a month with), and felt pretty cool speeding off into the rain. Not so cool. Shoes soaked, puddle water sprayed up my back, face speckled with rain I emerged from the parkade steaming. Not only was I a little damp, I was positively drenched. Right down to my knickers. What to do, what to do? Soggy knickers, hmmm.
A little known fact is that the most comfortable underwear in the world are in fact disposable hospital underwear. How do I know, you ask? I just happen to have experience sitting in pools of amniotic fluid while catching babies and have tried them in the past. So I snuck into the triage room (getting a couple of strange looks) and did the deed. At first sight they look like a pile of gauze, however, on closer inspection they are more like white fishnet stocking (in a square-ish shape). They may look a bit odd, but they do the trick. It would not have mattered that they were unsightly if it wasn't for the fact that all the scrubs have a hole where the drawstring tie at the side that either show off your thigh or your underwear, depending on your style. Yup, jokes on me Vancouver, apparently it rains here.
Either I'm going to have to keep a disposable knicker stash in my locker or I'll have to invest in some fenders. The fenders may be the least humbling option.
I know, I know, this is not something I hadn't heard before, but now I've actually experienced it. For several weeks now as I drank in the glorious sunny days and beautiful evenings I've thought this 'Vancouver is rainy and gray' stuff was an unsubstantiated, vicious rumour. Turns out its true.
Monday morning dawned gray and soggy. I grabbed my fancy gortex jacket (yes, the one that I could have fed a small village for a month with), and felt pretty cool speeding off into the rain. Not so cool. Shoes soaked, puddle water sprayed up my back, face speckled with rain I emerged from the parkade steaming. Not only was I a little damp, I was positively drenched. Right down to my knickers. What to do, what to do? Soggy knickers, hmmm.
A little known fact is that the most comfortable underwear in the world are in fact disposable hospital underwear. How do I know, you ask? I just happen to have experience sitting in pools of amniotic fluid while catching babies and have tried them in the past. So I snuck into the triage room (getting a couple of strange looks) and did the deed. At first sight they look like a pile of gauze, however, on closer inspection they are more like white fishnet stocking (in a square-ish shape). They may look a bit odd, but they do the trick. It would not have mattered that they were unsightly if it wasn't for the fact that all the scrubs have a hole where the drawstring tie at the side that either show off your thigh or your underwear, depending on your style. Yup, jokes on me Vancouver, apparently it rains here.
Either I'm going to have to keep a disposable knicker stash in my locker or I'll have to invest in some fenders. The fenders may be the least humbling option.
Tuesday, July 17, 2007
I didn't get the memo
I didn't get the memo that said doctors don't get to cuddle babies. Its one of lives profound injustices that the nurses get all the fun. They just didn't mention in medical school that due to my official title I would just never have the time to sit in a rocking chair and hold a newborn, and even if I did have the time, this was clearly not my job.
So I'm pretending I don't know. In the rare moments between following up a hemoglobin, ordering packed red cells and assessing a woman to see if she really has broken her water I sneak out the back door of the nursing station, across the hall, and into the special care nursery. They know me now.
The world slows down between the rows of boxed babies. I breath calmly, life is now as it should be, things have stopped moving at warp speed. A brand new complete package of humanity, a whole being, nestled in my arms. My world stops spinning out of control. Delicate fingers grasping out at the harsh world, miniature monkey toes on my palm and I am at peace with the universe.
In the photo archive that is my early life, there is picture after picture of me holding babies. When I was no more than 4 years old I remember my mom propping my arm on a pillow so it wouldn't get tired as I sat and gazed at the little nose, soft tiny ears. In an instant all my rambunctious, mischievous, hyperactive traits ceased and I sat in stillness, a miracle my mother would say.
During my time in Africa, I would come to town from my village, sometimes exhausted and disillusioned, unsure that there was any good left in this world of pain. All I had to do was sit on Mama Kiri's porch with a two year-old Baraka in my arms, waking up from his nap to know that all was well in the world, that there is always new life and hope and peace.
I smile as I see a grunt and then feel a rumbling in the diaper, my pager conveniently pierces the silence and I'm jolted back into a different world as I stand up from the rocking chair and tuck baby back into her box. Apologizing profusely to the nurse for not changing the diaper of course and off to see why Mrs. Jones can't pee.
So I'm pretending I don't know. In the rare moments between following up a hemoglobin, ordering packed red cells and assessing a woman to see if she really has broken her water I sneak out the back door of the nursing station, across the hall, and into the special care nursery. They know me now.
The world slows down between the rows of boxed babies. I breath calmly, life is now as it should be, things have stopped moving at warp speed. A brand new complete package of humanity, a whole being, nestled in my arms. My world stops spinning out of control. Delicate fingers grasping out at the harsh world, miniature monkey toes on my palm and I am at peace with the universe.
In the photo archive that is my early life, there is picture after picture of me holding babies. When I was no more than 4 years old I remember my mom propping my arm on a pillow so it wouldn't get tired as I sat and gazed at the little nose, soft tiny ears. In an instant all my rambunctious, mischievous, hyperactive traits ceased and I sat in stillness, a miracle my mother would say.
During my time in Africa, I would come to town from my village, sometimes exhausted and disillusioned, unsure that there was any good left in this world of pain. All I had to do was sit on Mama Kiri's porch with a two year-old Baraka in my arms, waking up from his nap to know that all was well in the world, that there is always new life and hope and peace.
I smile as I see a grunt and then feel a rumbling in the diaper, my pager conveniently pierces the silence and I'm jolted back into a different world as I stand up from the rocking chair and tuck baby back into her box. Apologizing profusely to the nurse for not changing the diaper of course and off to see why Mrs. Jones can't pee.
Wednesday, July 11, 2007
Who really failed?
Nurse: So, does she really have late stage cancer?
Me: Probably, its not looking very good.
N: When where you guys going to let her know about what you think?
M: Oh, you mean she doesn't know?
N: She doesn't have any idea.
M: Right, I'll get on that.
An anxious discomfort gnawed at my gut. I paged my senior resident who told me just to go ahead and let her know we thought it might be cancer but still had to run more tests (classic cop out doctor line . . . more tests.) In med school you practice 'breaking bad news', but its with actors as patients and your classmates are on the other side of the 2-way mirror ready to give you feedback.
A soft-spoken artist in her late 50s had come to the emergency department vomiting, abdomen distended, complaining of gradual weight loss over the last year, drenching night sweats, and weakness. She had a bowel obstruction. When I felt her stomach later it had a huge tender irregularly shaped mass that went from her pelvis to above her belly button. She hadn't been feeling well for a long time she said, but enemas and vitamins from her naturopath had been helpful on and off. On further questioning she had actually had menstrual bleeding for the last six years. We were always taught that bleeding after menopause means uterine cancer until proven otherwise. Imaging showed nasty necrotic masses. On exam foul smelling pus and blood oozed freely from her cervix. She had known she hadn't been well, but earlier in life had been seriously scarred by her interactions with the medical system and had avoided it at all costs. I felt this woman deserved so much more than what a two week-old doctor could give.
So I went to talk with her now that she had been up on the ward for a day. After pleasantries about her orchids and art, nausea and pain, I tried to explain some things.
Me (outside voice): We're worried this might be cancer in your uterus.
Her: Oh, so what's next?
Me (inside voice): If it was me I'd just take off into the wilderness and spend my last months surrounded by beauty . . . or maybe sky-diving, hmmmmm . . .
Outside voice: We'd like to do some more tests to see what our options are.
Her: Do you think its bad?
Inside voice: Bad? No, not bad, try horrific. Or maybe more of a tragic injustice of unimaginable consequence!
Outside voice: We don't know, but it does sound like you've been sick for a while.
She asked a few more questions, which I could only answer in the same evasive manner. We were transferring her to the cancer center and they would admit her there. But then she was quiet . . . pensive, overwhelmed, swimming in this new reality. What was going through her head? Anger? Regret? Sadness? Or a complete unawareness of what was happening?
I suppose it was tempting to join my colleagues in the anger band-wagon, to say that alternative medicine practitioners do more damage than good, that they even kill people and should be held responsible. But instead I was overwhelmed with sadness. Sadness that we had failed this woman. Bleeding for six years. In unexplained pain for over a year, and yet she would not come see a doctor until she was in agony, unable to even eat. What damage had Western medicine done to her in the past that she was so hesitant to seek help?
Maybe if we had listened, maybe if she had been heard years ago. Then I would be meeting her at an art show not sitting on her bed with the curtain drawn around it in a muggy shared hospital room. I'm going to wipe the image of the weak pale woman laying powerlessly in a foreign bed from my mind and replace it with a vibrant artist molding a creation out of clay on a potter's wheel in a rustic home in interior BC.
Me: Probably, its not looking very good.
N: When where you guys going to let her know about what you think?
M: Oh, you mean she doesn't know?
N: She doesn't have any idea.
M: Right, I'll get on that.
An anxious discomfort gnawed at my gut. I paged my senior resident who told me just to go ahead and let her know we thought it might be cancer but still had to run more tests (classic cop out doctor line . . . more tests.) In med school you practice 'breaking bad news', but its with actors as patients and your classmates are on the other side of the 2-way mirror ready to give you feedback.
A soft-spoken artist in her late 50s had come to the emergency department vomiting, abdomen distended, complaining of gradual weight loss over the last year, drenching night sweats, and weakness. She had a bowel obstruction. When I felt her stomach later it had a huge tender irregularly shaped mass that went from her pelvis to above her belly button. She hadn't been feeling well for a long time she said, but enemas and vitamins from her naturopath had been helpful on and off. On further questioning she had actually had menstrual bleeding for the last six years. We were always taught that bleeding after menopause means uterine cancer until proven otherwise. Imaging showed nasty necrotic masses. On exam foul smelling pus and blood oozed freely from her cervix. She had known she hadn't been well, but earlier in life had been seriously scarred by her interactions with the medical system and had avoided it at all costs. I felt this woman deserved so much more than what a two week-old doctor could give.
So I went to talk with her now that she had been up on the ward for a day. After pleasantries about her orchids and art, nausea and pain, I tried to explain some things.
Me (outside voice): We're worried this might be cancer in your uterus.
Her: Oh, so what's next?
Me (inside voice): If it was me I'd just take off into the wilderness and spend my last months surrounded by beauty . . . or maybe sky-diving, hmmmmm . . .
Outside voice: We'd like to do some more tests to see what our options are.
Her: Do you think its bad?
Inside voice: Bad? No, not bad, try horrific. Or maybe more of a tragic injustice of unimaginable consequence!
Outside voice: We don't know, but it does sound like you've been sick for a while.
She asked a few more questions, which I could only answer in the same evasive manner. We were transferring her to the cancer center and they would admit her there. But then she was quiet . . . pensive, overwhelmed, swimming in this new reality. What was going through her head? Anger? Regret? Sadness? Or a complete unawareness of what was happening?
I suppose it was tempting to join my colleagues in the anger band-wagon, to say that alternative medicine practitioners do more damage than good, that they even kill people and should be held responsible. But instead I was overwhelmed with sadness. Sadness that we had failed this woman. Bleeding for six years. In unexplained pain for over a year, and yet she would not come see a doctor until she was in agony, unable to even eat. What damage had Western medicine done to her in the past that she was so hesitant to seek help?
Maybe if we had listened, maybe if she had been heard years ago. Then I would be meeting her at an art show not sitting on her bed with the curtain drawn around it in a muggy shared hospital room. I'm going to wipe the image of the weak pale woman laying powerlessly in a foreign bed from my mind and replace it with a vibrant artist molding a creation out of clay on a potter's wheel in a rustic home in interior BC.
Saturday, July 7, 2007
Invincible
One of the fascinating things about training in medicine is the extremes of emotion you experience. One moment invincible, smart, and compassionate, the next you are completely humbled, clueless, and incompetent. It makes for a strange feeling of conflict in your soul.
Had another amazing night of call, steady, no sleep. Sometimes I think babies are born despite our best efforts. A young woman who had recently moved from China came in after having contractions all day. All communication was through her cousin. In incredible pain (as tends to happen with labour, FYI) she had just been told an epidural wasn't an option due to a back injury. She was hysterical, she couldn't do it she said. She refused any exams to see how far down baby was. After 13 more hours of pain and screaming, a swift knee blow to my head and a kick in the arm (I do have an impressive bruise to show for it!) I was finally holding the floppy newborn in my hands . . . only to realize that the REALLY difficult part was sewing up the tear, which, uh, involves needles and such that are in no way compatible with a flailing patient. Completely humbled.
At handover in the morning, bleary-eyed and exhausted after going non-stop all night I was roasted by the chief resident for not medicating a woman with high blood pressure on the ward.
Yes, its true, I'm incompetent . . . and I would like it if we could discuss this with the group. Groan. How do I keep my heart soft and my skin thick?
Sped home on my bike, a bit wobbly, nearly missing a curb and a car. Changed clothes. Hopped into my car and headed to the ferry terminal and out to Saltspring island for the day. Sun, breeze, and beauty enveloped me as I slipped into unconsciousness on the top deck.
Had another amazing night of call, steady, no sleep. Sometimes I think babies are born despite our best efforts. A young woman who had recently moved from China came in after having contractions all day. All communication was through her cousin. In incredible pain (as tends to happen with labour, FYI) she had just been told an epidural wasn't an option due to a back injury. She was hysterical, she couldn't do it she said. She refused any exams to see how far down baby was. After 13 more hours of pain and screaming, a swift knee blow to my head and a kick in the arm (I do have an impressive bruise to show for it!) I was finally holding the floppy newborn in my hands . . . only to realize that the REALLY difficult part was sewing up the tear, which, uh, involves needles and such that are in no way compatible with a flailing patient. Completely humbled.
At handover in the morning, bleary-eyed and exhausted after going non-stop all night I was roasted by the chief resident for not medicating a woman with high blood pressure on the ward.
Yes, its true, I'm incompetent . . . and I would like it if we could discuss this with the group. Groan. How do I keep my heart soft and my skin thick?
Sped home on my bike, a bit wobbly, nearly missing a curb and a car. Changed clothes. Hopped into my car and headed to the ferry terminal and out to Saltspring island for the day. Sun, breeze, and beauty enveloped me as I slipped into unconsciousness on the top deck.
Wednesday, July 4, 2007
30 Hour Day
I tossed and turned all night, I knew I had to be at the hospital by 6:30am on Tuesday and that I wouldn't see my bed again until Wednesday. Stomach churning with possibilities of doom that I would not only witness but be the cause of.
Found the maternity ward, and eventually figured out the change room and scrubs. The funny thing about being a resident is that you have all-access cards that beep you into pretty much whatever locked door you want. The logical consequence of this is that it makes getting lost a whole new game because you can do so in so many more restricted areas.
Since everyone is switching services and rotations, of course we don't get an orientation. We 'divide and conquer' the list.
"You're an OB resident, this case would be great for you, oh, and also this one . . . and this one too." My mind swimming in details of different patients and which conversation I had with whom. Who had the C-section and who had the puffy legs? Which one was the mother holding her child at arms length as if she thought it might detonate at any moment? And who was the one who couldn't pee? My dreams of being the doctor that listens fully were deteriorating in front of my eyes as the pressure of rounding on all the patients and writing notes in their charts by 7:15am slowly pressed down on my shoulders as the minutes went by.
Initially the word 'doctor' caught on my tongue when I introduced myself to patients, it sounded like I was spitting it off out of my mouth with distaste. But all too easily it just started flowing. As if this is who I had always been. Perhaps helped by the fact that people just believe you, no one says, "yeah right, and I'm Madonna," or stands up and yells "can I get a REAL doctor in here please, someone's about to have a baby!"
By 9am I had already delivered a baby. All my bitterness towards the dehumanizing medical system melted away as I remembered how much I loved this. The pace, the emotion, the tears of pain and joy. The first gurgling cry of the squirming newborn, stunned and shocked into the light and coldness of our world. Partners and loved ones instantly gooey eyed at their first glance of this somewhat unsightly red, wrinkled, slimy little miracle which is writhing and yelling in indignation at life in front of them.
My pager keeps going off. Each time I gaze at it in wonder thinking that no one would actually be paging me if they really knew who I was. At about 8pm, my gut suddenly hungry I get a gynecology consult from hematology. A 50 year old undergoing leukemia treatment who started her period five days ago and has been hemorrhaging blood since then, getting daily transfusions. I'm tired and mildly frustrated that they didn't bother to call during the day but I haul myself up 4 flights of stairs to go and see her. She's delightful, a psychologist, currently reading one my favourite books, the No. 1 Ladies Detective Agency. I tell her reading it makes me wants to move to Botswana and sit on a porch drinking bush tea all day. Her husband comes in a bit later and I go over things with him as well. As I leave she tells me that I'm good at what I do, that not everyone has a bed-side manner and that I should keep mine. She feels so much better after talking to me, reassured and heard. Something wells up in my throat, she has no idea of the impact of her words on this young physician. I crack a joke then tell her that's high praise coming from a psychologist before I head off down the hall.
I'm struck by the circle I've just witnessed. I saw a new being breath their first breath, and now I sit and chat with someone whose breaths are numbered.
The night goes on, the attending orders sushi from across the street . . . boy do I love Vancouver! Another straight forward delivery unfortunately resulting in a nasty tear. I do my first episiotomy. More women labouring, some scared, some excited, some just tired. I love people. Listening to their worries, answering questions, sharing their joy. When the new residents come on in the morning and ask how the night was, I don't mention that I didn't get any sleep I find I can only talk about how lovely the people are that I got to hang out with.
Out of my scrubs, bike helmet in hand, I wander lost through the hospital again trying to find the parking garage where I left my bike 28 hours ago.
And then finally, bright sun, a cool wind cutting through my shirt. Gliding across Burrard bridge on my bike, the ocean and mountains close enough to touch, reminding me of the outside world that still exists outside yellow corridors. The mid-morning sun glints off the water at Kits beach where a family has already set up their towels on the sand for a day of swimming. Suddenly shocked at realizing that this too is real life, outside the brick walls and endless corridors of the hospital and that I want to live every moment of it. Its official, I have survived Day 1, and I'm even looking forward to Day 2, well, after I succumb to the deliciousness of my bed for a few hours.
Found the maternity ward, and eventually figured out the change room and scrubs. The funny thing about being a resident is that you have all-access cards that beep you into pretty much whatever locked door you want. The logical consequence of this is that it makes getting lost a whole new game because you can do so in so many more restricted areas.
Since everyone is switching services and rotations, of course we don't get an orientation. We 'divide and conquer' the list.
"You're an OB resident, this case would be great for you, oh, and also this one . . . and this one too." My mind swimming in details of different patients and which conversation I had with whom. Who had the C-section and who had the puffy legs? Which one was the mother holding her child at arms length as if she thought it might detonate at any moment? And who was the one who couldn't pee? My dreams of being the doctor that listens fully were deteriorating in front of my eyes as the pressure of rounding on all the patients and writing notes in their charts by 7:15am slowly pressed down on my shoulders as the minutes went by.
Initially the word 'doctor' caught on my tongue when I introduced myself to patients, it sounded like I was spitting it off out of my mouth with distaste. But all too easily it just started flowing. As if this is who I had always been. Perhaps helped by the fact that people just believe you, no one says, "yeah right, and I'm Madonna," or stands up and yells "can I get a REAL doctor in here please, someone's about to have a baby!"
By 9am I had already delivered a baby. All my bitterness towards the dehumanizing medical system melted away as I remembered how much I loved this. The pace, the emotion, the tears of pain and joy. The first gurgling cry of the squirming newborn, stunned and shocked into the light and coldness of our world. Partners and loved ones instantly gooey eyed at their first glance of this somewhat unsightly red, wrinkled, slimy little miracle which is writhing and yelling in indignation at life in front of them.
My pager keeps going off. Each time I gaze at it in wonder thinking that no one would actually be paging me if they really knew who I was. At about 8pm, my gut suddenly hungry I get a gynecology consult from hematology. A 50 year old undergoing leukemia treatment who started her period five days ago and has been hemorrhaging blood since then, getting daily transfusions. I'm tired and mildly frustrated that they didn't bother to call during the day but I haul myself up 4 flights of stairs to go and see her. She's delightful, a psychologist, currently reading one my favourite books, the No. 1 Ladies Detective Agency. I tell her reading it makes me wants to move to Botswana and sit on a porch drinking bush tea all day. Her husband comes in a bit later and I go over things with him as well. As I leave she tells me that I'm good at what I do, that not everyone has a bed-side manner and that I should keep mine. She feels so much better after talking to me, reassured and heard. Something wells up in my throat, she has no idea of the impact of her words on this young physician. I crack a joke then tell her that's high praise coming from a psychologist before I head off down the hall.
I'm struck by the circle I've just witnessed. I saw a new being breath their first breath, and now I sit and chat with someone whose breaths are numbered.
The night goes on, the attending orders sushi from across the street . . . boy do I love Vancouver! Another straight forward delivery unfortunately resulting in a nasty tear. I do my first episiotomy. More women labouring, some scared, some excited, some just tired. I love people. Listening to their worries, answering questions, sharing their joy. When the new residents come on in the morning and ask how the night was, I don't mention that I didn't get any sleep I find I can only talk about how lovely the people are that I got to hang out with.
Out of my scrubs, bike helmet in hand, I wander lost through the hospital again trying to find the parking garage where I left my bike 28 hours ago.
And then finally, bright sun, a cool wind cutting through my shirt. Gliding across Burrard bridge on my bike, the ocean and mountains close enough to touch, reminding me of the outside world that still exists outside yellow corridors. The mid-morning sun glints off the water at Kits beach where a family has already set up their towels on the sand for a day of swimming. Suddenly shocked at realizing that this too is real life, outside the brick walls and endless corridors of the hospital and that I want to live every moment of it. Its official, I have survived Day 1, and I'm even looking forward to Day 2, well, after I succumb to the deliciousness of my bed for a few hours.
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