"Hoedit, hoedit!" An escalating raspy voice calls down the hall to hold the elevator and his electric wheelchair whizzes into view as the doors close. I lunged for the open door button since my attending, chief resident, and two drunk guys in the elevator with me all seemed blissfully oblivious to what was going on.
I had seen him before in the halls. His long, thin frame propped awkwardly on his wheelchair, his body stiff. Most of both his feet are missing, bandaged and oozing but somehow he manages to hold his IV pole between them, in front of his chair as he motors around. The stubs of his index finger and thumb on his right control the joystick on his chair. I don't think he has any teeth and appears to be hooked up to a milky-yellow IV bag for all his nutrients. His pale face with sunken cheeks and stubble is friendly, the toothless grin never leaving, an unlit cigarette between his lips, he's on his way outside for a smoke. Smoking 'till his last days.
Yesterday was my first day of general surgery, and as Murphy's law goes, I was on call. Unlike obstetrics, there is no senior resident or attending staff 'in house' so you're it overnight unless something big happens...then you're it until help comes. The reason I bring up my friend with missing fingers and feet is that the general surgery resident on call 'cross-covers' for all the vascular surgery patients overnight. The vascular resident gave me a call before she went home (after her 36 hours stint or so) to let me know about some patients I might 'hear about' overnight. Two of them had various levels of legs amputated, both DNR (do not resuscitate). "We really thought they'd die over the weekend, so any day now really, just make sure they're comfortable." Vascular surgery seems terribly depressing. Reconnecting and propping open arteries in an attempt to get perfusion to limbs. Arteries choc-full of nasty fatty plaques from long lives of smoking, high cholesterol, diabetes, and obesity. When people think of why they shouldn't smoke they probably think of lung cancer, but really, the heart attacks and rotting amputated limbs ultimately affect more people and needless to say, the impact on quality of life is fairly monstrous.
So I scrambled to figure out the patients on my own team, before reviewing the other general surgery team's patients AND all these vascular patients who had had surgeries I understood in only a simple textbook manner.
My senior resident left at 8pm after we had swamped our way through about six consults and booked an appendectomy for surgery later that night. I had a clear 'to-do' list in my mind of paperwork, dictations, labs and a CT scan to follow-up on to make sure we couldn't 'turf' one of our patients in the emergency department to GI and avoid admitting her. It was quite clear that I should call him only if I was really really uncomfortable with what was going on, in which case I should definitely call him...a fine balance.
A call from the ward at 2am.
"Are you familiar with Mr. Jones?"
"Nope. But you can tell me about him."
"Well, he doesn't have a pulse (I swear there was a pause here) in his left foot."
"Oh...what surgery did he have? Has he ever had a pulse in that foot?"
"Bilateral fem-pop last week." Pause. I hear the flip, flip, flip through the chart. "Actually, I guess we haven't ever picked up his dorsalis pedis pulse."
"Good...uh...I mean, not good, but no change then. Are his vitals stable otherwise?"
"Yes, sorry to bother you."
"No really, its okay, thanks for letting me know."
I clunk the phone down with relief. After clicking the light off, I lay down again on the ancient, hard, creaky hospital bed with thinly disguised rubber pillow that are standard in the call rooms. I'm exhausted but sleep and adrenaline don't mix well. Constantly dreading a call about my little lady with a bowel obstruction whose pain I just got under control an hour ago. The knowledge that I also hold the trauma pager is like a ball of lead in my stomach. I do get some sleep, but the pages continue, slowly I get comfortable and my heart stops pounding each time I hear the beeping.
Morning does eventually come. No one died, well, on my watch at least. The frenzied surgery rounds begin. Warp speed in and out of patients' rooms so the surgery residents can get to the ORs on time. When we finish the chief turns to me and says in a cheery voice, "I know you're post-call, but there are some great cases in the OR today. They'd be perfect for you to see as an OB/GYN resident. You're free to stay all day if you'd like!" Honestly, I wasn't really sure if he was serious or not... since I had only know him for a day I chose the 'serious' option instead of breaking into uncontrollable laughter like I felt like doing. I ended up staying for two surgeries that admittedly were very relevant and they actually let me do a fair amount which was a good trade-off for bleary-eyedness. Too bad for the ani of those involved of course.
Tuesday, August 28, 2007
Thursday, August 23, 2007
To be known
My sister came to visit last week, I hadn't seen her since April. Post-call we went for what are advertised as 'the best' cinnamon buns in Vancouver and she listened to the exhausted kid sister who wishes she wasn't a doctor and doesn't really know how she'll survive residency or ever be in a healthy relationship. Then we hit IKEA so she could re-design my room. I had an unexplainable attraction to every single bed I saw, it was like a strong magnetic pull. She patiently pulled me out of each one I crawled into until we eventually got to the picture frame section where my energy was suddenly revived. I didn't have to be funny . . . or even awake apparently, she would still hang out with me in all my grumpy, sleepy, post-callness.
I managed to meet up with her for lunch on Davie street, just next to the hospital one day. She laughed at my scrubs and openly mocked me for wearing them in public. Of course, I hadn't had time to change clothes AND have lunch with her, how picky can you get?!? But she knows me. Underneath the Dr. name tag, stethoscope and greens I'm just a sister, as vulnerable, human, and mock-able as ever. And it felt good just to be me with no labels and no explanations.
On Galiano island, together we joked about the watery hippie chai they sold at the craft market, lacking in both substance and spice. My sister being the ultimate chai expert having drunk it on dodgy Indian trains in ceramic mugs. We read Harry Potter to each other on the beach with several smiles in our direction from passers-by. Then we did a rather soggy hike along a coast-line ridge, misty and beautiful. We were told it was a 'dry' rain . . . I still haven't got the west coast lingo down apparently since I have no idea how that describes pouring rain.
We talked about the past and the future, our hopes and fears, I laughed until my eyes watered. I was reminded of the power of being known and loved by someone. In the midst of the excitement and exhilaration of moving to an amazing new place, starting an overwhelming, scary, (and fantastic) new job you can sometimes push the loneliness away but it always pops up. My life seems like a never-ending cycle; wake-up, get on bike, work, come home, eat, run or bike, collapse into bed, then start over. I miss being known. I miss filling my time with people instead of activities. Which is why it was so good to remember that I am known. There may not be a tangible presence that I can touch, but I am known.
I managed to meet up with her for lunch on Davie street, just next to the hospital one day. She laughed at my scrubs and openly mocked me for wearing them in public. Of course, I hadn't had time to change clothes AND have lunch with her, how picky can you get?!? But she knows me. Underneath the Dr. name tag, stethoscope and greens I'm just a sister, as vulnerable, human, and mock-able as ever. And it felt good just to be me with no labels and no explanations.
On Galiano island, together we joked about the watery hippie chai they sold at the craft market, lacking in both substance and spice. My sister being the ultimate chai expert having drunk it on dodgy Indian trains in ceramic mugs. We read Harry Potter to each other on the beach with several smiles in our direction from passers-by. Then we did a rather soggy hike along a coast-line ridge, misty and beautiful. We were told it was a 'dry' rain . . . I still haven't got the west coast lingo down apparently since I have no idea how that describes pouring rain.
We talked about the past and the future, our hopes and fears, I laughed until my eyes watered. I was reminded of the power of being known and loved by someone. In the midst of the excitement and exhilaration of moving to an amazing new place, starting an overwhelming, scary, (and fantastic) new job you can sometimes push the loneliness away but it always pops up. My life seems like a never-ending cycle; wake-up, get on bike, work, come home, eat, run or bike, collapse into bed, then start over. I miss being known. I miss filling my time with people instead of activities. Which is why it was so good to remember that I am known. There may not be a tangible presence that I can touch, but I am known.
Monday, August 13, 2007
Urgent section... no senior
Rushing down the hall. Fumbling the ties of my mask as I walk together with the obstetrician.
Water running, pink foam covering hands. Scrub, scrub, scrub. Repeatedly. Nails, palms, individual fingers, one at a time. Wrists, then down the arm. Rinse, spraying water down my greens. Water running off my elbows. I back into the room through swinging doors, arms held out, at 90 degrees like a robot, hands pointing to the ceiling.
Sterile hand towel rough on my hands. I scoop my arms into the blue gown. Hands deep into latex gloves held out for me, snapping gratifyingly around my arms. Tight springiness of my gloves reassuring, sterile gown stiff as I move. The curves of the body on the table become only an anatomic circle of skin in a blue sterile operating field. Bright lights spotlight the belly swollen with pregnancy.
Cautery in place. Suction ready. Heart pounding. Hand steady. Knife. Exhilarated. Bleary eyes fully cleared with the adrenaline of the cut.
Flash of custard yellow shiny fat globules as the skin parts, then bright red specs, spread and flood the incision. Deeper now, a sheen of fat particles on the surface of pooling red blood. Tiny fountain from an artery. Snapping of clamps. Cautery buzzing. Pungent smell of burning blood, tissue, smoke. Suction slurping. Snipping scissors slice through fascia. Knife again. Green fluid spurts. Cord floats out. Then pressure. I'm standing on a stool pressing all my weight down onto her belly while matted wet black hair emerges from below. Scrunkled, wrinkled face finally forced out. Body gray, covered with thick whitish-yellow paste. A girl. Pause. Breathing stops. Silence. Snap. Snap. Scissors snip. Slimy warm limbs held tightly in my hands, I turn and place her in the sterile white flannel the nurse is holding. No cry. Suction slurps. Heads crowd around the warmer. Hands flying. Then a gurgling cry, squirming baby. The room breaths again.
Blood spurts, flooding the uterus as the placenta slips out. Warm, pulsating. Clamps, sutures. Suction squealing as dark livery clots dangle off its tip. Ties. Cautery. Gauze. Gaping uterus closed, fascia comes together. Back up to the custard fat, no longer shiny. Krink krink krink as I staple the final edges together.
Only now does my heart slow, tearing off my gown, gloves sticky with dried blood snapped into the garbage. Blood and fluid all over my ankles and feet. Scattered bloody footprints bright on the floor.
Wading in the exhilaration of it all. Senses overloaded. Wow, that was cool.
Water running, pink foam covering hands. Scrub, scrub, scrub. Repeatedly. Nails, palms, individual fingers, one at a time. Wrists, then down the arm. Rinse, spraying water down my greens. Water running off my elbows. I back into the room through swinging doors, arms held out, at 90 degrees like a robot, hands pointing to the ceiling.
Sterile hand towel rough on my hands. I scoop my arms into the blue gown. Hands deep into latex gloves held out for me, snapping gratifyingly around my arms. Tight springiness of my gloves reassuring, sterile gown stiff as I move. The curves of the body on the table become only an anatomic circle of skin in a blue sterile operating field. Bright lights spotlight the belly swollen with pregnancy.
Cautery in place. Suction ready. Heart pounding. Hand steady. Knife. Exhilarated. Bleary eyes fully cleared with the adrenaline of the cut.
Flash of custard yellow shiny fat globules as the skin parts, then bright red specs, spread and flood the incision. Deeper now, a sheen of fat particles on the surface of pooling red blood. Tiny fountain from an artery. Snapping of clamps. Cautery buzzing. Pungent smell of burning blood, tissue, smoke. Suction slurping. Snipping scissors slice through fascia. Knife again. Green fluid spurts. Cord floats out. Then pressure. I'm standing on a stool pressing all my weight down onto her belly while matted wet black hair emerges from below. Scrunkled, wrinkled face finally forced out. Body gray, covered with thick whitish-yellow paste. A girl. Pause. Breathing stops. Silence. Snap. Snap. Scissors snip. Slimy warm limbs held tightly in my hands, I turn and place her in the sterile white flannel the nurse is holding. No cry. Suction slurps. Heads crowd around the warmer. Hands flying. Then a gurgling cry, squirming baby. The room breaths again.
Blood spurts, flooding the uterus as the placenta slips out. Warm, pulsating. Clamps, sutures. Suction squealing as dark livery clots dangle off its tip. Ties. Cautery. Gauze. Gaping uterus closed, fascia comes together. Back up to the custard fat, no longer shiny. Krink krink krink as I staple the final edges together.
Only now does my heart slow, tearing off my gown, gloves sticky with dried blood snapped into the garbage. Blood and fluid all over my ankles and feet. Scattered bloody footprints bright on the floor.
Wading in the exhilaration of it all. Senses overloaded. Wow, that was cool.
Wednesday, August 8, 2007
The problem with pain
She came in weeks ago, blissfully oblivious to how her world was literally about to turn upside-down. We'll call her Suzie. She was at her routine 20 week ultrasound and they found that she was 4cm dilated. That's bad news. A diagnosis of cervical insufficiency, meaning your cervix just doesn't stay closed if any pressure is put on it. Previously, its been called cervical incompetency, somehow implying a deficiency on the mother's part, that she was incompetent in carrying a baby. An active high school teacher, Suzie was now given the choice of a 'rescue' stitch in her cervix and complete bed rest until delivery (with a fairly low success rate), or to just let labour happen and put in a prophylactic stitch early in her next pregnancy. Suzie and her hubby chose the procedure and bed rest. They desperately wanted this pregnancy, having already experienced two miscarriages. It would be at least 4 weeks until baby would even be a candidate for resuscitation at 24 weeks. As days went by, and turned into weeks, Suzie bled a bit, sometimes she cramped. Then we wouldn't even let her up to the bathroom and we but her in 'Trendelenburg' position, so she lay every day, all day, with her head far below her feet. Scared even to have a bowel movement.
At 23 weeks, babies born are not resuscitated, the cut-off for viability is 24 weeks, even then, only 50% actually survive and 85-90% will be blind, deaf, or have mental or physical disabilities. But parents can request resus at 24 weeks. After 25 weeks, resuscitation happens most of the time, regardless of parental choice. A strange set of rules, built like a fence around the ethical principles of trying to do more good than harm.
We were updated each day, until she hit 23 weeks and 5 days. Suzie's water broke, she went into labour and we had to take her to the operating room to remove the stitches so they wouldn't completely tear through her cervix and permanently damage it for any future attempts at pregnancy.
Some images will forever be burned into my mind, and this is one of them. A small, tight, shiny membrane slowly proceeding from the vagina, feet first. Tiny feet in a glass globe coming out towards us, each only 2 or 3 cm long with five delicate, miniature toes on each foot. Imprinting their footprints forever onto my heart as they came.
We swam in the sorrow and intensity of the moment. The air felt like viscous liquid around me. Their grief making waves that hit each person in the room. Completely enveloping me in the heart-wrenching, soul-destroying pain of the present moment. A father's tears dripping freely onto the face of his tiny tiny son, swaddled in towels, eyelids still fused. Time stood still. Masked faces in sterile gowns blurred in the periphery of the operating room and the only thing real was a husband and wife, a sister gazing and embracing this tiny being, silently yelling out in agony, guilt, and anger. Raw. Abject. The physical pain and emotional intensity of this delivery not followed by pure joy and sheer bewilderment at the miracle of a new living, breathing, crying being that most deliveries have.
I've watched dozens of partners, mothers, and friends watch their loved one go through the exquisitely miserable pain of labour. Some are so uncomfortable they have to leave often, to get ice chips, a blanket, anything, to feel like they are doing something. I remember one husband unable to coach or encourage, but could only hold his wife's head close to his, looking straight into her eyes, never moving for over an hour, being fully present in her reality with unspoken intensity. Its near impossible to watch someone go through such agonizing suffering and not be able to alleviate it or share their burden. Being a religious person, pain and suffering are central to my understanding of our place in the world and really, a huge part of what life is all about. Sharing in the messiness and aching of humanity, crying out in unison at all the injustice that life may bring.
This past week, a dear dear friend of mine had to have labour induced after her baby was found to no longer have a heartbeat. It wasn't unexpected, and we had discussed all sort of options and decisions they may have had to make in the future. But the all-consuming brokenness and grief that comes with the loss of a child, with all the hopes for their future is devastating. It gave my experiences at work a whole new meaning. Dimensions that I never imagined were clear to me, as I saw my friend's story in each of my patients. Her fears and her dreams, and now her brokenness. There are no neat answers to explain the pain. No glib words of comfort or encouragement. This all-consuming pain must be experienced completely and without filters.
Pain is a personal thing. You can witness it, you may even share in it and feel like you're drowning in it, but it must always be owned. You can't take it away from someone else to free them from it. Somehow, unexplainably, I find hope in the midst of these messy emotions. A hope found in the knowledge that this pain is at the center of what it means to be truly human.
At 23 weeks, babies born are not resuscitated, the cut-off for viability is 24 weeks, even then, only 50% actually survive and 85-90% will be blind, deaf, or have mental or physical disabilities. But parents can request resus at 24 weeks. After 25 weeks, resuscitation happens most of the time, regardless of parental choice. A strange set of rules, built like a fence around the ethical principles of trying to do more good than harm.
We were updated each day, until she hit 23 weeks and 5 days. Suzie's water broke, she went into labour and we had to take her to the operating room to remove the stitches so they wouldn't completely tear through her cervix and permanently damage it for any future attempts at pregnancy.
Some images will forever be burned into my mind, and this is one of them. A small, tight, shiny membrane slowly proceeding from the vagina, feet first. Tiny feet in a glass globe coming out towards us, each only 2 or 3 cm long with five delicate, miniature toes on each foot. Imprinting their footprints forever onto my heart as they came.
We swam in the sorrow and intensity of the moment. The air felt like viscous liquid around me. Their grief making waves that hit each person in the room. Completely enveloping me in the heart-wrenching, soul-destroying pain of the present moment. A father's tears dripping freely onto the face of his tiny tiny son, swaddled in towels, eyelids still fused. Time stood still. Masked faces in sterile gowns blurred in the periphery of the operating room and the only thing real was a husband and wife, a sister gazing and embracing this tiny being, silently yelling out in agony, guilt, and anger. Raw. Abject. The physical pain and emotional intensity of this delivery not followed by pure joy and sheer bewilderment at the miracle of a new living, breathing, crying being that most deliveries have.
I've watched dozens of partners, mothers, and friends watch their loved one go through the exquisitely miserable pain of labour. Some are so uncomfortable they have to leave often, to get ice chips, a blanket, anything, to feel like they are doing something. I remember one husband unable to coach or encourage, but could only hold his wife's head close to his, looking straight into her eyes, never moving for over an hour, being fully present in her reality with unspoken intensity. Its near impossible to watch someone go through such agonizing suffering and not be able to alleviate it or share their burden. Being a religious person, pain and suffering are central to my understanding of our place in the world and really, a huge part of what life is all about. Sharing in the messiness and aching of humanity, crying out in unison at all the injustice that life may bring.
This past week, a dear dear friend of mine had to have labour induced after her baby was found to no longer have a heartbeat. It wasn't unexpected, and we had discussed all sort of options and decisions they may have had to make in the future. But the all-consuming brokenness and grief that comes with the loss of a child, with all the hopes for their future is devastating. It gave my experiences at work a whole new meaning. Dimensions that I never imagined were clear to me, as I saw my friend's story in each of my patients. Her fears and her dreams, and now her brokenness. There are no neat answers to explain the pain. No glib words of comfort or encouragement. This all-consuming pain must be experienced completely and without filters.
Pain is a personal thing. You can witness it, you may even share in it and feel like you're drowning in it, but it must always be owned. You can't take it away from someone else to free them from it. Somehow, unexplainably, I find hope in the midst of these messy emotions. A hope found in the knowledge that this pain is at the center of what it means to be truly human.
Friday, August 3, 2007
Lost in Dictation
I didn't have to do much dictating in medical school, but now that I'm a lowly resident there isn't a day that goes by without having to participate in this dreadful ritual. How it works? You call a number, and talk to the phone about a patient. You have to do it for all consults, deliveries, and yes, the dreaded discharge summaries which get sent to the family docs so they have a clue about what's happening to their patients. It was only in my third week that I discovered the pause and rewind buttons, those poor, poor, people who have to transcribe these things! "Ummm . . . uhh . . . note to transcriber, delete that last sentence . . . uh . . . I . . . uh meant to say . . . " Then last week, I had my first official doze-off during a discharge summary which I was trying to do before going home post-call . . . I'm such a dimwit!
As my friends and family can attest, I have a mumbling problem. In regular conversation, this isn't an issue, people just look at me funny and I pause and repeat. One friend, in the middle of an animated story I was telling her, tilted her head to the side, squinted her eyes and said, "funny, sound is coming out, but your lips just aren't moving." Unfortunately, as I found out when I actually read one of the consults I dictated, it may become a more of an issue. One of my patients ended up having a 67cm abscess in her pelvis. Now, even if you're not an expert in abscesses or the pelvis, wouldn't you maybe question something the size of an exercise ball being drained through someone's vagina?!? It was actually 6-7cm of course, but reading it on the computer I laughed out loud, imagining this slim woman waddling around. I was at the nursing station and everyone promptly assumed I was on Facebook. Hehehe, nope, doesn't take much to amuse me.
It made me think of one of my classmate's attempts at getting some tips on how to dictate and googled "medical transcription tips". The results were hilarious, although I can only remember a few of them:
1) When dictating, please place the receiver as far into your armpit as possible and whisper softly.
2) If you need to cough or sneeze at any time, please remove from armpit, and do so directly into the phone receiver.
3) Please make sure to spell out uncommon names like "Brown" or "Smith" but don't waste time spelling simple names like Ghchoayeyzfhgfr.
Then some of the mistakes that have been made:
1) Because the couple is having trouble conceiving, I have referred them to a futility expert.
2) On rectal exam, the thyroid was found to be enlarged.
3) During her first visit to the emergency department, she was examined, x-rated, and discharged home.
So my new goal is to speak clearly, mostly to avoid medico-legal problems in the future, and ultimately, I sure hope those nice people at transcription have a whole lot of patience and a sense of humour (I always thank them copiously after each dictation).
As my friends and family can attest, I have a mumbling problem. In regular conversation, this isn't an issue, people just look at me funny and I pause and repeat. One friend, in the middle of an animated story I was telling her, tilted her head to the side, squinted her eyes and said, "funny, sound is coming out, but your lips just aren't moving." Unfortunately, as I found out when I actually read one of the consults I dictated, it may become a more of an issue. One of my patients ended up having a 67cm abscess in her pelvis. Now, even if you're not an expert in abscesses or the pelvis, wouldn't you maybe question something the size of an exercise ball being drained through someone's vagina?!? It was actually 6-7cm of course, but reading it on the computer I laughed out loud, imagining this slim woman waddling around. I was at the nursing station and everyone promptly assumed I was on Facebook. Hehehe, nope, doesn't take much to amuse me.
It made me think of one of my classmate's attempts at getting some tips on how to dictate and googled "medical transcription tips". The results were hilarious, although I can only remember a few of them:
1) When dictating, please place the receiver as far into your armpit as possible and whisper softly.
2) If you need to cough or sneeze at any time, please remove from armpit, and do so directly into the phone receiver.
3) Please make sure to spell out uncommon names like "Brown" or "Smith" but don't waste time spelling simple names like Ghchoayeyzfhgfr.
Then some of the mistakes that have been made:
1) Because the couple is having trouble conceiving, I have referred them to a futility expert.
2) On rectal exam, the thyroid was found to be enlarged.
3) During her first visit to the emergency department, she was examined, x-rated, and discharged home.
So my new goal is to speak clearly, mostly to avoid medico-legal problems in the future, and ultimately, I sure hope those nice people at transcription have a whole lot of patience and a sense of humour (I always thank them copiously after each dictation).
Wednesday, August 1, 2007
3 kisses and a love note
Today was an exceptionally good day.
It started out with a patient leaving us a large box of chocolate truffles. Absolutely heavenly, or devilish, I can't quite decide, either way, they were so good it was practically scandalous. Creamy richness melting on my tongue.
Then my lovely little Thai patient gave me a big sloppy kiss on the neck when she was hugging me on the way out the door (after she had a picture taken with baby and me). She may have been going for my cheek, but she just wasn't tall enough, her chin was about up to my elbow.
Later in the day my other favourite patient, a young girl here doing a masters from Ecuador, wrote me a sweet note on a postcard from Quito. Her story had inspired me and the nurses had found me more than once just sitting chatting with her and her mom in their room. I'm keeping the note to read on the bad days:
Agosto 1, 2007
Dra Shohona,
Espero que siempre conserves tu sonrisa y buen caracter, y que alegres a tus pacientes. Exitos y bendiciones. Gracias por todo.
Rita, Karla, y Nicole
That was two more kisses which put my tally up to three, although I'm not sure if Ecuadorian 'besitos' really count. Its more like shaking hands, everyone kisses everyone in Ecuador! Oh well, I'll count them anyway.
I realize that I'm deeply blessed and privileged to share just a little of the beauty of life with each of these people, each with their own stories of love and pain.
Today there was also a memorial held for the woman who died last week. Unfortunately I couldn't make it, but the still fresh memories of death and sorrow made a striking juxtaposition on the joy and gratefulness I was filled with today. Life is such a contradiction, so hard yet happy, so miserable yet lovely. But today, today was a good day.
It started out with a patient leaving us a large box of chocolate truffles. Absolutely heavenly, or devilish, I can't quite decide, either way, they were so good it was practically scandalous. Creamy richness melting on my tongue.
Then my lovely little Thai patient gave me a big sloppy kiss on the neck when she was hugging me on the way out the door (after she had a picture taken with baby and me). She may have been going for my cheek, but she just wasn't tall enough, her chin was about up to my elbow.
Later in the day my other favourite patient, a young girl here doing a masters from Ecuador, wrote me a sweet note on a postcard from Quito. Her story had inspired me and the nurses had found me more than once just sitting chatting with her and her mom in their room. I'm keeping the note to read on the bad days:
Agosto 1, 2007
Dra Shohona,
Espero que siempre conserves tu sonrisa y buen caracter, y que alegres a tus pacientes. Exitos y bendiciones. Gracias por todo.
Rita, Karla, y Nicole
That was two more kisses which put my tally up to three, although I'm not sure if Ecuadorian 'besitos' really count. Its more like shaking hands, everyone kisses everyone in Ecuador! Oh well, I'll count them anyway.
I realize that I'm deeply blessed and privileged to share just a little of the beauty of life with each of these people, each with their own stories of love and pain.
Today there was also a memorial held for the woman who died last week. Unfortunately I couldn't make it, but the still fresh memories of death and sorrow made a striking juxtaposition on the joy and gratefulness I was filled with today. Life is such a contradiction, so hard yet happy, so miserable yet lovely. But today, today was a good day.
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